Gerontology Sleep/Physical Activity/Fall Risk

The nurse completes an admission assessment on an older adult patient. The nurse identifies which factor that may contribute to sleep problems? a. Exposure to sunlight c. Use of a sleep aid b. Polypharmacy d. Decreased fluid intake

ANS: B Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy.

The nurse can place an older adult into one of four patient rooms. Which is the most suitable room for an older adult? a. Brightly lit, blue room with cozy throw rugs b. Room with orange carpeting and soft lighting c. Brightly lit, blue room with waxed vinyl floors d. Room for television and childrens playtime

ANS: B The soft lighting avoids glare, and the carpet provides better traction than a glossy floor. Lamps should be added to supply more light when desired. Throw rugs easily slip, and older adults can trip on them, resulting in injury. The patients feet should not be able to glide easily across the floor, and when the surface becomes wet, a waxed floor can be very slippery. The patient may stumble over children and toys.

During the night, an older woman complains to the nurse that she has not slept more than 2 hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this womans sleep? a. Inquire about her sleep habits used at home. b. Suggest that she avoid napping during the day. c. Tell her that sleep is fragmented in older people. d. Offer a book to her or suggest watching a movie.

ANS: A Hospitalization often disrupts normal sleeping patterns; therefore reestablishing those patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this womans problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy, but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep.

1. Which of the following is a true statement about sleep in older adults? a . The time spent in bed increases, but the time spent asleep decreases. b . The amount of leg movement during sleep remains steady throughout life. c . Rapid-eye-movement (REM) sleep becomes more unevenly distributed with age. d . The amount of stage III sleep increases steadily throughout life.

ANS: A Older persons tend to spend less time asleep than younger persons, although they spend more time in bed. This statement is true because sleep takes longer to arrive and is more fragmented. Leg movements during sleep often tend to increase with age. REM sleep becomes more evenly distributed with age. Stage III sleep decreases with age and virtually disappears in older adults.

An older man has Alzheimer disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the mans duration of sleep? a . Instruct the wife to increase his daily physical activity. b . Collaborate with the health care provider to administer a hypnotic medication. c . Teach the wife how to apply a vest restraint during sleep. d . Help the wife plan daily periods for napping and activity.

ANS: A Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem.

The nurse is caring for an older adult who has dementia. The patient has just returned from recovery after a percutaneous endoscopic gastrostomy (PEG) tube placement. Which intervention(s) should the nurse implement? (Select all that apply.) a. Place IV tubing behind the patient. b. Hang the IV bag behind the patients field of vision. c. Cover the PEG tube with an abdominal binder. d. Use wrist restraints.

ANS: A, B, C Placing the tube behind the patient, hanging the IV bag behind patients field of vision, and covering PEG tube with an abdominal binder decrease the likelihood of the patient accidently pulling out the lines. Soft mitts should be used instead of hand restraints.

The nurse will be educating a group of senior citizens on adaptations for safer driving. Which adaptation(s) should the nurse include? (Select all that apply.) a. Wide rear-view mirrors b. Pedal extensions c. Global positioning system (GPS) devices d. Antiroll bars

ANS: A, B, C Wide rear-view mirrors, pedal extensions, and GPS devices are all suggested adaptations. The use of antiroll bars has not been identified as an adaptation.

Residents of a nursing home taking which of the following medication(s) are at risk for sleep disturbances as an adverse effect of the medication? (Select all that apply.) a. Celecoxib (Celebrex) b. Diltiazem (Cardizem) c. Venlafaxine (Effexor) d. Ipratropium (Atrovent) e. Oxycodone (Oxycontin) f. Guaifenesin (Robitussin)

ANS: A, B, C, D, E Celecoxib (Celebrex), a cyclooxygenase-2 (COX-2) inhibitor; diltiazem (Cardizem), a calcium- channel blocker; venlafaxine (Effexor), an antidepressant; ipratropium (Atrovent), an anticholinergic bronchodilator; and oxycodone (Oxycontin), an opioid analgesic, can all cause insomnia. Guaifenesin (Robitussin) is not known to cause insomnia.

The nurse plans care to prevent a dangerous thermal environment for an older man who lives in a northern climate of the United States. Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.) a. Has a history of a cerebrovascular accident (CVA) b. Has a history of diabetes mellitus c. Builds miniature cars for a hobby d. Bathes three to four times a week e. Gets heat from a boiler in the cellar f. Becomes diaphoretic on warm days

ANS: A, B, C, E A CVA can impair an older adults thermoregulatory center and potentially diminish the individuals awareness of temperature changes or the ability to respond suitably to a temperature change. In addition, if the older adult is left with a cognitive deficit or aphasia, then the older adults ability to communicate a thermal problem is potentially impaired. A history of diabetes mellitus can contribute to a dangerous thermal environment for the older adult. A complication of diabetes is peripheral neuropathy, which potentially impairs the ability to sense temperature change. In addition, peripheral arterial disease associated with diabetes contributes to the individuals ability to compensate to temperature changes with vasodilation or vasoconstriction. Building miniature cars is a sedentary activity. The associated metabolic activity is low, the older adult generates less heat from metabolic activity, and the individual is at a higher risk for hypothermia when the temperature is cool. Household heat from a boiler in the cellar creates a potential regulatory problem for the older adult living in the building because adjustments to temperature affect the entire household and are only made in the cellar. Thermostats in individual rooms do not exist in such a heating system. If the individual has impaired mobility, then he might be unable to navigate the stairs to the cellar and adjust the temperature. Bathing three to four times a week limits the exposure of bare skin to the cooling effects of evaporation to reduce the risk of hypothermia. Diaphoresis on a warm day is a suitable response to heat.

Which factors in the patient care environment should be routinely assessed to decrease the risk of falls? (Select all that apply.) a. Outdoor grounds b. Appropriate footwear c. All four bed rails raised d. Grab bars in place

ANS: A, B, D The outdoor grounds should be checked for uneven areas, such as breaks in the sidewalk and items the patients could trip over. Ensuring that patients have the appropriate footwear in important to decrease the risk for falls. Raised bed rails can be considered a restraint. Grab bars are considered assistive devices and can decrease the risk for falls or injuries.

Which of the following is(are) assessed in a fall prevention assessment of an older adult? (Select all that apply.) a. Environment b. Physical status c. Financial status d. Functional status e. Medical history f. Occupational history

ANS: A, B, D, E The nurse uses information about lighting, flooring, apparel, and other issues from the environmental assessment of an older adult to plan individualized fall prevention measures. The nurse examines flexibility, muscle strength, vital signs, and other clinical indicators in the physical assessment of an older adult to plan individualized fall prevention measures. The nurse uses information about gait, balance, and ability to perform activities of daily living in the functional status assessment of an older adult to plan individualized fall prevention measures. The nurse examines medications, previous accidents and falls, co-morbid conditions, and other factors in the historical assessment of an older adult to plan individualized fall prevention measures. Financial issues and occupational history are not directly related to a risk for falls.

A nurse will be conducting an education session at the local senior citizens center on the importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.) a. Biking c. Weight lifting b. Range of motion (ROM) d. Dancing

ANS: A, D Biking and dancing incorporate large muscle groups and are classified as moderate-intensity aerobic activity. ROM exercises are classified as stretching activities. Weight lifting is considered an exercise that uses body weight and is a muscle-strengthening activity.

The nurse should encourage which of the following exercise(s) to assist with balance for a patient who is at high risk for falls? (Select all that apply.) a. Tai chi c. ROM activities b. Use of resistance bands d. Walking heel to toe

ANS: A, D Tai chi and walking heel to toe are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM activities are considered stretching exercises.

The nurse determines that an older adult who has chronic bronchitis is at high risk for falls, but he repeatedly tries to ambulate without assistance. Which alternative measure to restraints is contraindicated for this older adult? a. Inform the staff about his risk for falls. b. Place a concave mattress on the bed. c. Provide frequent walks in the hallway. d. Help him learn to use an assistive device.

ANS: B A concave mattress is a restraint alternative, but it is contraindicated for this patient who has chronic bronchitis because lowering the relative position of his torso in relationship to the head and lower extremities places extra pressure on the diaphragm and restricts chest expansion, which makes the work of breathing significantly more difficult for him and is contraindicated because chronic bronchitis is an obstructive breathing disorder. Communicating the risk for falls is a suitable alternative measure to restraints for him; it employs multiple people to observe, manage, and lower his fall risk. Providing frequent walks can be an effective restraint alternative for this older adult if he is restless or bored. Finally, the nurse can help him learn how to use an assistive device to help avoid the use of restraints.

Which of the following is a true statement about sleeping in older adults? a . Older adults tend to fall asleep quickly but are awakened throughout the night. b . Sleep disturbances in the older adult can be caused by cardiovascular disease, arthritis, or diabetes. c . Benzodiazepine agents are the medications of choice for sleep disorders. d . Selective serotonin-reuptake inhibitors (SSRIs) can alleviate sleep disturbances caused by depression.

ANS: B All of these physical problems, as well as arthritis, can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more frequently than younger people. Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a hangover after waking that can increase the risk of accidents and injuries. In addition to alleviating depression that causes sleep disorders, SSRIs can have a stimulating effect that, in itself, interferes with the sleep cycle.

Which of the following statements is true about a safe, effective care environment for older adults? a . Cold beer with steak and potatoes is a good meal for an older adult on a hot day. b . Older drivers are more likely to be in a fatal motor vehicle accident than younger drivers. c . Barrier-free buses and low fares make public transit a safe transportation option. d . A nurses perception of temperature is a useful guide for patient thermal needs.

ANS: B Although older adults have safer driving habits (e.g., less night driving, less driving in heavy traffic, shorter distances, less speeding or drunk driving) than younger drivers, the physical and sensory changes of aging contribute to a higher incidence of fatal accidents for older adults. Hot, heavy meals and alcohol should be avoided when ambient temperatures exceed 90 F. The fear of crime often deters older adults from using public transit. The older adults perception of temperature is the important factor.

Exercises are prescribed for older adults as therapy to improve which one of the following qualities? a. Relative intensity c. Muscle retraining b. Muscle strength d. Body sculpting

ANS: B Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern.

An older man was oriented and responded appropriately in the hospital, but he is now disoriented and confused in his home after discharge. Which of the following issues is the first that the home nurse should examine to determine whether an environmental issue is contributing to the patients condition at home? a. Complaints of shivering b. Temperature of household c. Types of food preparation d. Presence of radon

ANS: B Older adults are at higher risk of hypothermia in the community because hypothermia is difficult to detect and because, as hypothermia sets in, the older adult can respond to a lower temperature. This man has clinical indicators of hypothermia; therefore the home care nurse first assesses the ambient temperature for a baseline determination because the household temperature should have the most profound impact on his body temperature. Asking about shivering can be ineffective with an older adult who is confused and disoriented; the response can be incorrect. However, to display respect, the nurse should ask the question. The type of food preparation can offer additional clues about the older adults hypothermia and mental status; if he is eating cold foods such as sandwiches and yogurt, then he can be unwittingly contributing to the problem. Presence of radon in the home may lead to lung cancer, not confusion.

A nursing home resident who has type 1 diabetes mellitus is gradually requiring more and more insulin on an as-needed (PRN) basis to treat hyperglycemia. Which of the following should the nurse assess to plan care for improving this individuals glucose metabolism? a. New-onset urinary tract infection b. Trends over time in activity level c. Sudden increase in caloric intake d. Big change in diabetic medication use

ANS: B Standard diabetic therapy includes diet, hypoglycemic agents, and exercise. If one aspect of the therapy changes, then the other two aspects must be adjusted to avoid hyperglycemia. Improving glucose metabolism is a huge benefit of exercise for the person with diabetes. In all people, exercise helps maintain aerobic conditioning, stabilizes mood, improves the quality of sleep, and is especially important for those with diabetes to promote and maintain collateral circulation. For this resident, a slow decline in physical activity will necessitate a change in the amount of insulin given or the total amount of daily calories to prevent hyperglycemia; however, the best solution for this resident is to increase daily physical activity. A new event is likely to cause an abrupt change in the serum glucose. Although infections are frequently detected in an individual with diabetes, infections are more closely associated with sudden-onset hyperglycemia. A sudden increase in caloric intake is likely to cause a sudden increase in blood glucose. A big change in medication use is likely to cause an abrupt change in the serum glucose.

The nurse wants to use exercise according to the recommendations of the American Geriatrics Society (AGS) for an older woman who lost her balance and fell. Which nursing intervention is suitable for this older adult according to the AGS? a . Tell her to use an assistive device until her balance improves. b . Provide information on group exercises for balance training. c . Help her to learn how to exercise the core group of muscles. d . Instruct her to enroll in an exercise program for 8 weeks.

ANS: B The AGS states that group exercises can be effective to improve balance as part of a fall prevention program for older adults. Using an assistive device can help prevent falls; however, assistive devices are not part of an exercise program. Although the AGS states that the relationship between exercise and reducing the risk for falls is strong, the recommended type, duration, and intensity of the exercises are not clear. The AGS states that to improve balance with exercise, an older adult must participate in exercise for at least 10 weeks.

The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care? a. Do not exercise a red, warm, or swollen joint. b. Avoid stretches that cause you to bend at the waist. c. Evaluate your surroundings for outdoor exercising. d. Begin by warming up with low-to-moderate exercises.

ANS: B The nurse needs more information because the reason the residents height has decreased is not known. Therefore to obtain the information, the nurse decides to complete a resident assessment before planning an exercise program. The shrinkage can be due to atrophy of intervertebral discs, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by incorrectly exercising. With a complete assessment, however, the nurse can plan a suitable exercise program for the resident. Red, warm, swollen joints are usually due to gout or rheumatoid arthritis; fortunately, the resident does not have these health problems. However, this is a good recommendation for anyone who exercises. Evaluating an individuals surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; however, this is a good, general recommendation for anyone who exercises. Warming up with low-to-moderate exercises is a good recommendation for anyone who exercises.

The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use? a. Two full-length rails b. One -length rail c. No side rails d. Four -length rails

ANS: B The use of one -length rail is not considered a restraint; it can be used to assist the patient in getting in and out of bed. Two full-length rails and four -length rails would be considered a restraint. The use of no side rails is not considered a restraint; however, the use of one rail to maneuver in and out of bed may be most beneficial to the patient.

Which of the following should the nurse recommend for a moderate-intensity exercise for older adults who are ambulatory and in good health? a. Walk 4 miles in 60 minutes. b. Work in the garden for 45 minutes. c. Swim laps in the pool for 20 minutes. d. Wash and wax the car for 75 minutes.

ANS: C According to the American Geriatrics Society, the nurse can safely recommend swimming laps for 20 minutes consecutively to older adults. The nurse can safely recommend walking 2 miles in 30 minutes, but walking for 60 minutes is excessive. Older adults should limit gardening to 35 to 40 minutes at a time. The older adult can wash and wax a car for a combined 45 to 60 minutes.

Which of the following is important to include in the initial assessment for older adults who are frail and beginning an exercise program? a. Exercise tolerance testing (ETT) b. Financial ability to pay for training sessions c. Medical history and physical examination d. Pulmonary function tests (PFTs)

ANS: C Any aspect of the patients current and past physical and psychological condition can be important in designing the exercise program to suit the patient. Fitness tests such as the ETT are warranted in older adults who are beginning a moderately intense or vigorous exercise program. The ETT is not recommended for the frail older adult. Expensive training programs are not usually needed. Although aerobic capability must be carefully observed, PFTs, specifically, are not necessary unless pulmonary function is a parameter that the therapeutic program is targeting for improvement.

An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this womans sleep? a. Recommend preparation for sleep. b. Suggest trying a cup of warm milk at bedtime. c. Inquire about her nightly sleep rituals. d. Propose volunteer work at a thrift shop.

ANS: C The nurse completes an assessment of the womans sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment.

The nurse expresses concern about a female nursing home resident in the team meeting. Which resident information determines the teams priority in planning her care? a. Experiences several interruptions with sleep b. Has had coronary bypass graft surgery during the last year c. Needs increasing help with personal hygiene d. Eats insufficient calories to maintain her weight

ANS: C The residents ability for self-care is deteriorating, and needing help with personal hygiene is an indicator of declining health because the level of activity is an indicator of an individuals health and wellness. Thus declining health is the nurses priority in planning care. Assessing and addressing medical problems, such as heart disease and nutrition, and improving sleep are among the aspects of care to restore health and well-being for which the nurse will plan. Improving sleep patterns is part of the overall plan to restore her health and wellness. A history of coronary artery disease is important information to use to plan care; however, it is part of the plan to improve the womans overall health. Improving nutrition is part of the overall plan to restore her health and wellness.

The overall temperature in your gerontological unit is 62 F during the evening shift. In documenting this concern to the administration, which factor is the most important for the health and well-being of older adults? a . It is not fair for older adults to have to deal with an uncomfortable environment. b . Some of the residents are wearing blankets around their shoulders to keep warm. c . An ambient temperature of 62 F is unsuitable for older people because they have impaired thermoregulation. d . It feels much warmer in the administration wing than out in the patient care areas.

ANS: C Under no circumstances should the temperature drop below 65 F because older adults are at risk for hypothermia. Furthermore, frail older adults need the temperature to be considerably higher. The issue is not one of fairness but a more fundamental issue of patient safety. Some of the residents wearing blankets may represent individual temperature preferences. The purpose is to make the point that the patients are vulnerable to low temperatures, not to make veiled accusations against the administrators.

The nurse assesses the quality of which of the following patient characteristics when applying the Get-Up-and-Go test from the Hendrich II Fall Risk Model? a. Stride b. Speed c. Balance d. Flexibility

ANS: C Using the Get-Up-and-Go test, the quality of the older adults movements is assessed. The nurse instructs the individual to rise from a chair, walk, and return to the chair and be seated. The stride is not specifically assessed in this test, although it is an aspect of gait and can be a factor in balance. The older adults speed is not assessed in this test. Flexibility is not specifically assessed in this test, although it can be an important factor in balance.

The nurse observes that a male patient is snoring every night. Which should the nurse assess in this patient to diagnose the potential for sleep apnea? (Select all that apply.) a. Change in appetite b. Rituals for sleeping c. Number of daytime naps d. Headaches in the morning e. Irritability during the day f. Awakening during the night

ANS: C, D, E, F The nurse asks the patient to evaluate how restorative or refreshing sleeping is for him; awakening unrefreshed is a risk factor for sleep apnea. In addition, morning headaches, daytime irritability and personality changes, and periods of nighttime wakefulness are all risk factors for sleep apnea. Changes in appetite and rituals for sleeping are rarely associated with an increased risk for sleep apnea.

Which one of the following is a true statement about mobility and safety for older adults? a Use of restraints on older patients helps prevent injuries from falls. . b Falls that do not cause physical injury are not significant. . c The get-up-and-go test provides a measure of a patients energy and initiative. . d Lowering the bed and fluorescent tapes are interventions to increase safety. .

ANS: D Adjusting the bed height to match the length of the residents lower leg and marking the path from the bed to the toilet with bright fluorescent tape are some of the many possible interventions to improve residents safety. Restraints have not been shown to increase safety and may contribute to morbidity and mortality. Even if a fall does not cause injury, it can contribute to the fear of falling, inhibiting activities of daily living. The Get-Up-and-Go test, in which the person rises from a straight-backed chair, walks 10 feet, returns, and sits down, assesses balance and gait.

Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? a . A walker can be used when climbing stairs. b . Cane tips should be smooth. c . Older adults save money by adapting assistive devices from their friends. d . A cane is most useful for unilateral disabilities but not bilateral problems.

ANS: D Canes can relieve stress on arthritic joints on one side. A walker can equally relieve pressure on joints on both sides. Cane tips should be flat on the bottom with a series of rings, not smooth. Older adults are tempted to save money by using assistive devices from nonmedical sources; however, regardless of the source of the assistive device, the device should be fitted to the older adult. An older adult should never try to adapt to the assistive device; an ill-fitted device can contribute to falls and injuries. Using a walker is contraindicated when climbing stairs. Improperly selected or improperly used assistive devices can be risk factors for falling.

What is the difference between rest and sleep? a. Sleep occurs with rest. b. Rest is an extension of sleep. c. Rest occurs only in brief periods. d. Sleep is restorative and recuperative.

ANS: D Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep.

After assessing the older man in his bed, the nurse determines that he is at high risk for falls. The nurse leaves the room to get a fall risk sign and returns to find him on the floor pleading for help. Which of the following was the most important intervention the nurse should have implemented to prevent this event? a. Call for someone to bring the sign. b. Show the older man how to use the call bell. c. Provide a urinal and drinking water. d. Instruct the patient to call for help.

ANS: D The nurse accomplished the most important aspect of fall prevention with the assessment. However, in an attempt to communicate the fall risk to other staff members, the nurse failed to communicate properly to the patient about fall prevention before leaving the room. Calling for someone to bring the sign would have been a reasonable approach to communicating the risk of falls, but it does not take the place of directly instructing the patient about prevention. The needs of an older adult can contribute to the risk of falls as an individual leans and reaches for something; therefore call bell instructions are a reasonable approach for preventing falls. However, before providing the call bell instructions, the nurse needed to tell him to call for help. A urinal and drinking water are common items that an older man needs, but reaching for them can contribute to falls.

The older adult residents of an assisted-living facility are preparing for a 14-day trip to Europe. Which is the most important exercise for the nurse to recommend for the group? a. Practice standing on one foot for 30 seconds. b. Move light weights in a rowing motion eight times. c. Stretch the hips by pulling the knee to the chest. d. Swim laps in the pool for 10 minutes continuously.

ANS: D The nurse should recommend endurance exercises for the group to improve cardiovascular and respiratory conditioning. Endurance training is suitable to prepare the residents to withstand the rigors of travel. Standing on one foot for 30 seconds is a reasonable exercise to recommend because balance tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. Moving light weights is also a reasonable exercise to recommend because muscle bulk tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. Stretching the hips is a reasonable exercise to recommend because joint flexibility tends to decrease with age; however, the cornerstone of the groups exercise must be endurance.

The nurse is discharging an older woman who uses a walker from rehabilitative care. Which observation does the nurse use to determine whether the patient is prepared for discharge? a. She holds the front of the walker. b. She has a walker with four wheels. c. She takes four steps into the walker. d. She takes the walker to the elevator.

ANS: D The older adult uses the elevator to travel between floors of a building, demonstrating that she knows not to use a walker on the stairs and is thus safe to discharge. Older adults should use the arms of a walker for stability. A walker with four wheels can be easy to move; however, such ease of movement does not provide enough stability to be suitable as an assistive device. To use a walker correctly, she should take two steps at a time into the walker.

An older woman who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially? a. Apply bilateral upper extremity restraints. b. Administer haloperidol (Haldol) for agitation. c. Close the door to her room to reduce the noise. d. Determine the patients needs.

ANS: D To help maintain her independence and permit the administration of IV fluids yet provide safe, effective care, the nurse should determine what the patient is attempting to convey and then address those needs. Restraining one side creates a potential threat from the other arm to the integrity of the IV, but bilateral restraints can be justified for the protection of the IV site. However, as a first step, the nurse should determine if the patient has a need that has not been met before moving to a restraint. Administering an antipsychotic agent can be justified for agitation but not in this patient. Less intrusive measures are available for initial protective measures. Although nurses tend to keep the doors of patients and residents rooms slightly ajar to maintain privacy, closing this womans door is contraindicated to control noise because it can contribute to the risk of falls and injury and does nothing to maintain the integrity of the IV.