Gerontology Exam 3 Ch. 9, Ch. 8, Ch. 3

The nurse in the long term-care facility knows older adults are at an increased risk for falls due to orthostatic hypotension due to which age-related change to the cardiovascular system?

Vascular tissue sclerosis

The outermost layer of the skin is the

epidermis The epidermis, the outermost layer of the skin, is an important structure that provides protection for internal structures, keeps out dangerous chemicals and microorganisms, functions as part of the body's fluid regulation system, and helps regulate body temperature and eliminate waste products.

In people older than age 65, what is the leading cause of death by injury?

falls Fall the leading death caused by injury in people older than age 65 and the most common cause of nonfatal trauma-related hospital admissions.

Health screenings are done to

identify older adults who need further assessment. Health screenings are done to identify older individuals who are in need of further, more in-depth assessment.

Glaucoma is a disease characterized by

increased fluid pressure within the eye Glaucoma is a disease characterized in most cases by increased fluid pressure (intraocular pressure) within the eye that may result in damage to the retina.

The peak years of physiologic function last from the

late teens to late 30s. The peak years of physiologic function last from the late teens through the 30s - the so-called prime of life.

The patient presents to the emergency department and is diagnosed with heatstroke. The nurse knows this diagnosis is made because of which imbalance?

low sodium levels

To use a walker correctly, the patient

needs to have some arm strength and the ability to maintain balance A walker requires some arm strength and the ability to maintain balance. A patient should only use a walker if he or she can support themselves properly.

The 80-year-old patient presents to the clinic for a routine check-up. The nurse notes the patient has a stooped appearance with rounded upper back and head bent forward to the chest. How should the nurse document this observation?

Kyphosis

The nurse is recording subjective data of a patient recently admitted following a myocardial infarction. The patient states, "I have never been so scared in my life. On Tuesday, it felt like an elephant was sitting on my chest and I couldn't catch my breath." How should the nurse chart this information?

"The patient stated, 'I have never been so scared in my life. On Tuesday, it felt like an elephant was sitting on my chest and I couldn't catch my breath'"

The nurse on the orthopedic surgery unit knows it is vital to prevent patient falls to improve the lives of patients and the economy, as the direct cost of falls exceeds which number?

$30 billion

The nurse is assessing the older adult patient using the SPICES screening tool. Which questions would be helpful to complete the screening tool? (Select all that apply.)

- "Have you noticed your sleep patterns have changed in the past year?" -"Do you have difficulty getting to the bathroom on time?" -"Have you fallen in the past 3 months?"

The nurse in the long term care facility knows patients with which disorders are at an increased risk for falls? (Select all that apply.)

- diabetes - parkinson's disease - cerebrovascular accident

The nurse caring for an older adult on the medical/surgical unit knows which medication categories, if administered to the patient, would increase the patient's risk for falls? (Select all that apply.)

- diuretics - antihypertensive

The nurse is performing a fall risk assessment on a 72-year-old patient recently admitted to the long term care facility. The patient has never fallen before, uses a walker, suffers from type 2 diabetes mellitus, osteoarthritis, depression, and complains of difficulty hearing, stress incontinence. Which characteristics increase this patient's risk for falls? (Select all that apply.)

- use of a walker - hearing loss

The 71-year-old patient presents to the clinic for her routine exam. While reviewing the patient's chart, the nurse notes the patient's most recent blood pressure screening, mammogram, and clinical breast exam were performed at age 70. She last had her cholesterol levels checked at age 68. Her last guaiac test and colonoscopy were performed at age 69. The nurse knows this patient should have which screening test(s) performed? (Select all that apply.)

-Guaiac test -Blood pressure -Screening for obesity

The nurse in the long term care facility who cares primarily for older adults knows which common age-related musculoskeletal changes result in decreased lung capacity and can affect the respiratory health of her patients? (Select all that apply.)

-Intercostal muscle atrophy -Calcification of costal cartilage -Barrel-chest shape due to kyphosis

The nurse is reviewing routine lab results for a 78-year-old patient and notes the patient's white blood cell count is markedly elevated. The nurse is concerned about which condition for this patient?

Leukemia

Which are normal age-related changes? (SATA)

-decreased visual acuity -increased gastric pH -decreased serum albumin -decreased rate of peristalsis The rate of legal blindness and visual impairment increases significantly in later years of life, particularly after age 75 years. Expected heart rate associated with aging is 40-100 beats per minutes. The upper limit of normal blood pressure is now 130/80 mm Hg, so a reading of 134/84 mm Hg would indicate hypertension. A gastrointestinal change with aging includes a decrease in the amount of acid produced in the stomach, which leads to a higher gastric pH. A musculoskeletal change associated with aging is decreased muscle mass. A respiratory change associated with aging is decreased muscle strength and endurance, which results in decreased ability to breathe deeply. A gastrointestinal change associated with aging is decreased peristalsis; therefore caloric requirements are decreased. Serum albumin decreases with aging, which can lead to edema. Subcutaneous tissue is decreased. A gastrointestinal change associated with aging is decreased gastric motility and peristalsis.

The nurse caring for older adults in the community knows which diseases are the most common causes of disability in this population? (Select all that apply.)

-hypertension -diabetes mellitus -cardiovascular disease -cerebrovascular accident

What are patients who have had Parkinson disease for 10 yrs likely to exhibit? SATA

-rigidity and tremors when at rest -dementia People suffering from Parkinson disease may manifest a variety of symptoms. The initial signs of the disease tend to be unilateral and include slight tremors on one side in addition to a more general weakness and slowing down. As the disease progresses, these tremors become typical and obvious when the person is at rest, decrease with conscious movement, and are totally absent during sleep. Later in the course of the disease, both sides of the body become affected. Tremors increase, the body becomes more rigid, and movements become slower. The face takes on a flat, open-mouthed, mask-like expression, and eye blinking decreases in frequency. Speech slows and may be unclear. Eighty percent of people with Parkinson disease develop Parkinson Disease Dementia after 10 years.

The nurse is preparing to assess the blood pressure of a patient and measures the patient s arm to determine the proper sized cuff. The diameter of the patient s arm is 50 cm. How wide should the blood pressure cuff be? Record your answer as a whole number.

60

Which environment would be best for conducting an interview with an older adult?

A warm, diffusely lit patient room with access to a bathroom An interview room should have minimal distractions, diffused lighting, comfortable furniture, easy access to a bathroom, and privacy for confidential discussion.

Which blood vessels carry blood away from the heart?

Arteries The arteries are blood vessels that carry blood away from the heart. With the exception of the pulmonary artery, arteries carry oxygenated blood.

Your team is developing a fall reduction program on your unit. Which of the following would be important to remember when developing such a program?

Assessment for fall risk factors should be done upon initial assessment when being admitted to a facility, and any time there is a change in patient condition. Removing environmental hazards will help decrease falls caused by tripping. Placing signage indicating someone's fall risk will help alert the team and visitors of the risk. Both medication reviews and supervised exercise groups have been shown to reduce one's fall risk. Restraints should only be used as an intervention of last resort, as they can lead to patient injury or death.

Which method is used to evaluate heart sounds?

Auscultation Auscultation uses the sense of hearing to detect sounds produced within the body. Heart, lung, and bowel sounds are typically assessed using auscultation.

When performing an assessment of the gastrointestinal system of an older adult, the nurse would proceed in what order? (first to last)

Before starting a physical assessment, the nurse will use interviewing techniques to obtain a health history. Once the history is obtained, the nurse is then ready to proceed to the physical assessment. Complete physical assessment should be done in an orderly manner so that no important observations are missed. Assessment should begin with an overview of the person and proceed with more focused assessments. The most common method of physical assessment is a head-to-toe approach in which the entire body is assessed systematically. An assessment of the gastrointestinal system of an older adult would begin with the health history and then proceed from head to toe, starting with inspection and progressing to auscultation and lastly palpation.

Which of the following statements is an example of objective data?

Blood pressure is 150/65 mm Hg.

The nurse caring for older adults knows age-related changes to the epidermis affect the older adult in which manner?

Body temperature regulation is impaired.

What allows free movement of the joint surfaces?

Cartilage The freely moving synovial joints are lined with cartilage, which allows free movement of the joint surfaces.

The nurse in the long term care facility knows it is vital to be vigilant for cases of pneumonia in his patient population. Which symptom may be the first indication of atypical pneumonia in the older adult?

Confusion

Older adults developing various disease processes may present with different symptoms from younger adults. The nurse would be concerned about which disease if the patient were to demonstrate a decreased appetite, constipation, and changes to his sleep pattern in which he is awake at night and sleeps during the day?

Depression

The nurse is assessing a patient and counts a respiratory rate of 8 breaths per minute. The nurse should be concerned about which condition?

Impending infection

The nurse caring for older adults on a cardiology unit at a hospital understands the hearts of older adults respond to adrenergic stimulation by making which change to increase cardiac output?

Increase stroke volume

Which method is the most commonly used during physical assessment?

Inspection spection is the most commonly used method of physical assessment. The senses of vision, smell, and hearing are used to collect data.

The nurse in the long term care facility knows each resident will be assessed using which comprehensive tool to determine care needs and appropriate interventions?

Minimum Data Set 3.0

At first contact, the proper way to address the older adult women is

Mrs. Reynolds During your first contact with a patient, it is best to address the person using their formal name. Appropriate use of names indicates respect and helps build rapport.

Why is it essential to collect accurate and complete data?

Nursing diagnoses and plan of care are formulated based on data.

A factor that contributes to the development of hypothermia in older adults is decreased

Older adults are highly susceptible to hypothermia for several reasons. Normal changes that occur with aging affect the body's ability to regulate temperature. Changes in the skin reduce the older person's ability to perceive dangerously hot or cold environments. Decreased muscle tissue, diminished peripheral circulation, reduced subcutaneous fat, and decreased metabolic rate affect the amount of heat produced and retained by the body.

Which method uses the sense of touch to obtain data?

Palpation Palpation uses the sense of touch in the fingers and hands to obtain data.

The home health nurse knows patients with which disorder are at an increased risk for heat stroke due to the medications that are often prescribed as treatment?

Parkinson's disease

The patient presents to the clinic complaining of abdominal pain. Which information should be charted as objective data?

Patient is hunched in her chair, clutching her abdomen

The method used least by nurses is

Percussion Percussion is the technique that is least used by nurses. It requires special skill and training.

An inflammation of the lungs caused by bacterial, viral, fungal, chemical, or mechanical agents is

Pneumonia Pneumonia is an inflammation of the lungs caused by bacterial, viral, fungal, chemical, or mechanical agents. In response to the agent, the alveoli and bronchioles become clogged with a thick, fibrous substances that decreases the ability of the lung to exchange gases.

The nurse palpates for the 78-year-old patient's radial pulse and counts 82 beats in one minute. Then, the nurse auscultates the patient's apical pulse and counts 94 beats per minute. The nurse knows which term describes this discrepancy?

Pulse deficit

The nurse is interviewing the patient who has recently been admitted to the long term care facility with the patient's son present. Although the nurse directly addresses the patient with each question, the patient's son interrupts and answers the question for the patient. How should the nurse best handle this situation?

Request the patient's son allow the patient to answer the questions

The aging patient presents to the clinic with multiple well-defined, small areas of skin that are more darkly pigmented than others on the hands, forearms, and face. How should the nurse document this finding?

Senile lentigo

Which manifestation indicates serious heat related problems?

Symptoms of hyperthermia are progressive. Mild, early signs of heat stress include feeling hot, listless, or uncomfortable. Cramps in the legs, arms, and abdomen are early indicators of elevated body temperature. Serious indications of heat-related problems include hot, dry skin without perspiration; tachycardia; chest pain; breathing problems; throbbing headache; dizziness; profound weakness; mental or perceptual changes; vomiting; abdominal cramps; nausea; and diarrhea.

Which assessment tool is most highly regarded and often used to determine the mental status of the older adult?

The Mini-Cog Many assessment tools are available to assist nurses in assessing mental status in older adults. Although others are also well known, the easiest and most highly regarded is the Mini-Cog.

When performing an interview with an older adult, the nurse should consider physical environment factors by

When performing a patient interview, attention to making the older adult comfortable is important, including providing an environment that is properly illuminated, but not too brightly, as glare can be harsh on the older eyes. Temperature should be comfortable, and it is important to provide for physical needs (e.g., offering the bathroom before beginning) and privacy. One should begin the interview by explaining what to expect. Providing a nurse of the same gender is generally not required but should be accommodated if requested by the patient.

The nurse performs a skin assessment of an older adult. Which finding is abnormal and needs to be reported?

a dark elevated patch that bleeds when touched Unusual appearance of moles should be suspected to be melanoma. Irregular shapes, irregular borders, changes in color, changes in size, or symptoms, such as itchiness or bleeding are all considered abnormal.

The nurse is aware that the best predictor of an older adult falling is

a history of previous falls Falls are the most common safety problems in older adults. Any fall is the best predictor of future falls. Falling doubles the chance of someone falling again.

The nurse should instruct the nursing assistant who is caring for a client who is receiving antihypertensive medication to

allow them to stand up slowly from sitting or lying position. Medications often contribute to falls, and because older adults commonly take one or more medications, their risk for untoward effects is increased. Common types of hazardous medications include sedatives, hypnotics, tranquilizers, diuretics, antihypertensives, and antihistamines. Antihypertensive medications can cause dizziness or fainting with position changes caused by a sudden drop in blood pressure (orthostatic hypotension). Therefore, the patient receiving an antihypertensive should be encouraged to change to a standing position slowly to avoid symptoms of orthostatic hypotension.

An older adult is coming to your clinic for treatment for a gastric ulcer. Which treatment would the nurse expect to be ordered?

antibiotics Gastric ulcers are most commonly caused by the bacterium H. pylori, and antibiotics will usually be prescribed. NSAIDs are another commonly implicated cause, so these should be eliminated if possible. Iron, especially on an empty stomach, is very irritating to gastric tissues.

A person who can apply restraints should be

any staff person trained in restraint application. All staff, including nursing assistants, should be thoroughly trained regarding the use of each type of restraining device.

The leading cause of disability for older adults is

arthritis The leading cause of disability for adults in the United States is arthritis and other rheumatic conditions.

A condition likely to cause syncope is

atrial fibrillation Any cardiovascular condition that results in decreased cardiac output and decreased oxygen supply to the brain can cause older adults to experience vertigo (dizziness) or syncope (fainting). Common disorders with this result include anemia, cardiac arrhythmias, and orthostatic hypotension.

Hypothermia in older adults

can easily be confused with another condition. Many of the signs and symptoms of hypothermia are similar to those of other disorders in older adults, making it easy to miss or be mistaken for another condition.

What is the largest part of the human brain?

cerebrum The cerebrum is the largest part of the human brain. It is divided into lobes, which are named according to the cranial bones under which they lie.

Emphysema is characterized by

changes in the structure of the alveoli. Emphysema is characterized by changes in the alveolar structure. The alveoli lose elasticity, become overinflated, and are ineffective in gas exchange.

Your older female patient is complaining because she is having frequent urinary tract infections. Which normal age related change is most likely to be a contributing factor?

decreased bladder muscle tone The urinary change associated with aging that can make one more susceptible to UTI is decreased bladder muscle tone, because there may be increased residual volume of urine and the possibility of bacterial multiplication. Nocturnal urine production is increased with age, along with decreased perception of the need to void; however, neither contributes to UTIs. Incontinence is not a normal aging change and does not contribute to UTIs; however, incontinence might be a symptom of a UTI.

The home health nurse who cares for primarily older adults knows the age-related change of vision affects the older adult's awareness of position and speed of oncoming motor vehicles?

decreased depth perception

The ability to judge the distance of objects from the observer and from each other is called

depth perception Depth perception allows a person to properly judge the distance of objects, both from the observer and from each other.

The nurse encourages the patient to maintain a steady weight in the recommended range to decrease risk of which common endocrine disease observed in older adults?

diabetes mellitus The incidence of diabetes mellitus (DM) increases with age. The likelihood of acquiring diabetes rises sharply with each decade of life.

The home health nurse knows many older adults experience difficulty seeing up close. This age-related change puts the older adult at an increased risk for which event?

drug overdose

The nurse in the long term care facility notices that a patient complains of dizziness upon changing from a lying to sitting or sitting to standing position. The patient has fallen during transfers to and from the toilet recently. The nurse should assess the patient for which condition?

orthostatic hypotension

Which of the following conditions puts an older adult at higher risk for falls?

parkinson disease Older adults with neurologic disorders, such as Parkinson disease or stroke, experience weakness and alterations in gait and balance that increase fall risk.

What should the nurse explain when discussing expected changes in the female reproductive system to an older adult?

production of vaginal secretions decreases An expected physiologic change in the female reproductive system associated with aging is decreased estrogen levels, which results in decreased vaginal secretions.

In a hospital, an effective way to help prevent falls is to

put the call light within the patient's reach. Having a call light within reach is a good way to reduce the risk of falls for most patients. This allows the patient to summon help to get out of bed and move around the room or hospital.

When assessing the respiratory system of an older adult, the nurse hears continuous, coarse, low-pitched sounds. How would these be reported?

rhonchi (gurgles) Gurgles (low-pitched wheezes) are adventitious lung sounds characterized by continuous low-pitched sounds with a coarse snoring quality. They are cleared by coughing and are heard over the trachea and bronchi.

Older adults are at higher risk for hyperthermia because

sweating ability is decreased. When compared to younger adults, it takes longer for older adults to begin sweating, and, because of diminished thirst and decreased body water, they produce less perspiration.

It is more precise to

take a temperature reading.

When taking a radial pulse of an older adult, the nurse finds it difficult to count a weak and thready pulse. What should the nurse do?

take an apical pulse instead Weak, thready pulses are often seen in individuals with fluid volume deficits or electrolyte imbalances; full or bounding pulses may indicate excessive fluid volume. Weakness of a radial pulse may make palpation impossible and necessitate use of the apical route.

The older adult presents to the emergency department with cool skin, pallor, acrocyanosis, heart rate of 48 beats per minute, a shuffling, stiff gait, and apathy. The nurse should expect which additional vital sign?

temperature 34.5 c*

A factor that affects thermoregulation is

the amount of subcutaneous fat ternal factors that affect thermoregulation include muscle activity, peripheral circulation, amount of subcutaneous fat, metabolic rate, amount and type of foods and fluids ingested, medications, and disease processes.

A decrease in the function of sebaceous and sweat gland secretion increases the likelihood of

xerosis A decrease in the function of sebaceous and sweat gland secretion increases the likelihood of dry skin, or xerosis. Dry skin is probably the most comm skin-related complaint among older adults.