Med Surg I Prep U Chapter 11: Health Care of the Older Adult

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection?

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

A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate?

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

An older adult patient has just been admitted to a long-term care facility. Which of the following would be most important to reduce the risk for infection?

Use the purified protein derivative test to evaluate for tuberculosis.

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:

"What precipitates the outbursts?"

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

Barbiturates

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

Relaxed perineal muscle

Ageism refers to

bias against older people based solely on chronological age.

An older adult female patient tells the nurse, "I have lost an inch [2.5 cm] of height and have a hump on my back. What can I do about this?" What is the best response by the nurse?

"In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus."

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate?

Distract the client with a familiar object or music.

The plan of care for a patient with advanced Alzheimer's disease includes the nursing diagnosis of risk for injury. The nurse has identified this nursing diagnosis most likely as related to which of the following?

Impaired memory

Why are IV solutions usually given at a slower rate to older adults?

Older adults may have cardiac or renal disorders.

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

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

Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture?

Pneumonia

Which is an age-related change associated with the nervous system?

Postural hypotension

Which neurotransmitter is implicated in depression?

Serotonin

A nurse is reviewing the medications of a client who lives alone and reports having difficulty remembering when to take them. To aid in medication compliance, which of the following measures would the nurse employ? Select all answers that apply.

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

A nurse notes that an older female client has lost 2 inches in height since her appointment last year. The client reports lumbar back pain as unchanged. Which of the following would the nurse instruct the client? Select all answers that apply.

• Increase intake of foods that are high in calcium. • Take calcium and vitamin D supplements daily. • Obtain the prescribed bone density screening.

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply.

• Providing a calm, quiet environment • Supervising nutritional intake • Using familiar cues about the environment

When assessing an older adult, the nurse anticipates an increase in which component of respiratory status?

Residual lung volume

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

stay with the client and encourage him to eat.

An older adult patient is experiencing presbycusis. When interviewing the patient, the nurse would be alert for problems associated with which consonants? Select all that apply.

• F • S • P

The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply.)

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

Which action by the nurse demonstrates ageism?

Directing all health decisions to the older adult's child

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

Presbyopia

The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse?

Assess the need for pneumococcal and influenza vaccinations.

The nurse is working in a long-term care facility. When assessing her patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population?

Cardiovascular

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first?

Reorient the patient

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching?

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

Which is a true statement regarding pharmacologic aspects of aging?

Absorption may be affected by changes in gastric pH.

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

Ageism

Which condition is characterized by a decline in intellectual functioning?

Dementia

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes?

Decreased acetylcholine level

Which is an accurate rationale for why older adults are more susceptible to serious infections?

They have less efficient defense mechanisms.

Which characteristic distinguishes normal aging from pathological changes associated with aging?

Universality

The most common affective or mood disorder of old age is

depression

An elderly female client tells the nurse she has trouble holding her "water." A nursing intervention is informing the client to

have adequate fluid intake

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

Encouraging clients to avoid cigarette smoking

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

Ask if the mother could come in for a hearing evaluation.

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess?

Complaints about frequently waking up during the night

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

80%

After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching?

"I should use a laxative every other day."

An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate?

"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."

A patient with Alzheimer's disease is prescribed donepezil (Aricept). When teaching the patient and family about this drug, which of the following would the nurse include?

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

A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate?

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

The nurse is assisting an older adult patient with dietary planning. The nurse emphasizes the importance of adequate intake of fruits, vegetables, and fish. What should the patient's daily carbohydrate intake be?

55-60%

An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first?

Assess for the potential for self-harm.

A hospitalized older adult complains of increased coughing and shortness of breath. The nurse assesses the vital signs as temperature 100.2°F oral, respirations 18, pulse 88, and BP 128/80. What action should the nurse do next?

Assess lung sounds and sputum.

Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. The nurse

Assesses the grandmother for adventitious lung sounds

Which is an age-related change in the respiratory system?

Decreased gas exchange

Which factor alters urinary elimination patterns in older adults?

Decreased muscle tone

Students are reviewing information about age-related changes in the older adult. They demonstrate a need for additional study when they identify which of the following as an age-related change in the respiratory system?

Decreased residual lung volume

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to

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

When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal?

Feeling of fullness

Which are leading causes of death among the elderly?

Heart disease

Which are leading causes of death among the elderly? Select all that apply.

Heart disease

After teaching a group of nursing students about living arrangements for older adults, the instructor determines that the teaching was successful when the group identifies which housing option as used by most older adults?

Home

An elderly client experienced a cerebrovascular accident (CVA) and was unable to ambulate following his CVA. The client was transferred from a hospital and is now at a subacute care facility. For continuation of Medicare coverage, the nurse evaluates that the client must demonstrate

Improvement in ambulation

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to

Ingest five or six small meals each day.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to

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

An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to

Limit ingestion of caffeinated beverages.

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of

Loss of bone density

Students are reviewing information about visual changes and conditions associated with aging. The group demonstrates understanding of the information when they identify which condition as the major cause of vision loss in the elderly?

Macular degeneration

Students are preparing a class presentation on elder abuse. Which of the following would they include as the most common type of elder abuse?

Neglect

The reason that federal and state governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement?

Older adult clients are vulnerable.

An elderly client who lives in a retirement community is having a mild depressive episode over the past few weeks. The nurse intervenes by recommending

Participation in a social activity

An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to

Post a sign stating "You are in the hospital" at the client's eye level.

Which action is included in a nurse's role when providing home care for a client with Alzheimer disease?

Provide emotional and physical support

The nurse is assessing sleep habits of an elderly client who reports difficulty falling asleep and staying asleep. The nurse intervenes when the client reports he

Reads in bed before going to sleep

A nurse is preparing a health promotion class for a group of seniors at a local community center. As one part of the presentation, the nurse is planning to address sexuality and sexual function. Which statement would be least appropriate to include?

Sexual desire typically becomes progressively less.

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse?

Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore."

A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. The nurse tells the client to

Wear sunglasses with ultraviolet (UV) protection when outside.

The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply.

• Avoiding environmental smoke • Participating in regular exercise • Ensuring appropriate fluid intake

A nurse is preparing a presentation for a local senior citizen group about nutrition in the older adult. Which of the following recommendations would the nurse include? Select all that apply.

• Daily calcium intake of 1200 mg • Carbohydrate intake accounting for 55% of total calories consumed • Vitamin D intake of 600 IU per day

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply.

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