NUR 314 Chapter 28 Older Adults

Which of the following patients should the nurse see first? A. A patient with unilateral changes in vision B. A patient with ectropion of the lower lid C. A patient with presbyopia D. A patient with senile ptosis

A. A patient with unilateral changes in vision Rationale: Unilateral changes in vision might indicate a stroke, which should be treated as an acute situation. Presbyopia, ectropion, and ptosis are chronic conditions common in older adults.

The nurse is assessing an older adult with a persistent cough. The client states that he has never smoked a cigarette in his life. The client's vital signs are normal, and the client states that he feels fine other than the cough. What does the nurse know about the lungs of the older adult? A. Fewer cilia line the airways, making lung clearance more difficult B. More cilia line the airways, making lung clearance more difficult C. Increased lung rigidity makes lung clearance more difficult D. Decreased lung rigidity makes lung clearance more difficult

A. Fewer cilia line the airways, making lung clearance more difficult Fewer cilia line the airways of the lungs of older adults, decreasing the lungs' efficiency in clearing.

The nurse is assessing an older adult client's vaccination history. This aspect of the client's history will have a significant bearing on her risk for what health problem? A. Pneumonia B. Urinary tract infections C. Cellulitis D. Tuberculosis

A. Pneumonia The pneumococcal vaccine significantly reduces an older adult's risk of pneumonia. Vaccines do not exist for tuberculosis, UTIs, or cellulitis.

Which of the following statements is true concerning changes in the older adult? A. The lens becomes smaller and less dense. B. The tympanic membrane becomes more flexible and retracted. C. Changes in ear conduction can interfere with sound discrimination. D. Increased pupillary responses lead to difficulty in light accommodation.

C. Changes in ear conduction can interfere with sound discrimination. Rationale: As the older adult ages, sound discrimination is altered, making it difficult to hear voices when around a lot of background noise, such as a television. High-frequency sounds are lost most commonly, so older adults may have difficulty hearing an examiner with a high-pitched voice. The lens becomes more dense, tympanic membrane becomes less flexible, and the pupil has decreased response to light.

You auscultate a loud murmur in an older adult patient. You should also assess for which of the following? A. Coarse rhonchi and purulent sputum B. Irregular heartbeat and pulse deficit C. Crackles in the lungs and leg edema D. Abdominal distention and right upper quadrant (RUQ) tenderness

C. Crackles in the lungs and leg edema Rationale: A loud murmur indicates that there may be backflow of blood through the valve (regurgitation) or difficulty with the blood moving forward over the valve (stenosis). Regurgitation and stenosis may result in symptoms of heart failure. Coarse rhonchi and sputum indicate pneumonia, irregular heartbeat indicates a cardiac arrhythmia, and RUQ tenderness indicates a liver problem.

The Morse Fall Scale was developed for whom? A. Homebound elders B. Independent elders C. Hospitalized elders D. Confused elders

C. Hospitalized elders The Morse Fall Scale developed for hospitalized elders is widely used in hospital settings and does not require major training of staff.

When looking at a review of systems for an elderly client, which gastrointestinal data should cause the nurse the most concern? A. Reports of constipation B. Inability to digest dairy products C. Early satiety D. Decreased production of saliva

A. Reports of constipation The nurse should be most concerned about the report of constipation. Constipation is not a normal process of aging but many factors contribute to its presence. Production of saliva decreases, gastric emptying slows, and stool has a longer transit time. All these factors can lead to the development of constipation. A decrease in gastric emptying leads to early satiety. Lactose intolerance may develop for the first time in old age.

Which of the following findings are considered an expected change in the skin in older adults? Select all that apply. A. Solar lentigines (liver spots) B. Actinic keratoses C. Pressure injury D. Photoaging

A. Solar lentigines (liver spots) B. Actinic keratoses D. Photoaging Rationale: Pressure injuries in the sacral and ischial areas, greater trochanteric area, or heels should be staged and interventions begun immediately.

In an interview with an elderly female client, the nurse learns that the client often has involuntary loss of urine when coughing, sneezing, or laughing. What type of incontinence should the nurse document in the client's record? A. Stress B. Urge C. Overflow D. Functional

A. Stress The nurse should document the findings as stress incontinence. Urge incontinence is the involuntary loss of urine associated with an abrupt and strong desire to void. Overflow incontinence is the condition in which the client has involuntary loss of urine associated with overdistention of the bladder. Functional incontinence is the inability to get to the bathroom in time or to understand the cues to void due to problems with mobility or cognition.

The nurse assesses for geriatric syndromes, which are A. the interaction of multiple diagnoses that contribute to problems in the older adult. B. the exacerbation of chronic conditions, such as congestive heart failure or chronic obstructive pulmonary disease. C. conditions in which older adults may not mount an immune response. D. decreases in growth hormones and steroids that reduce functional status.

A. the interaction of multiple diagnoses that contribute to problems in the older adult. Rationale: Although no agreement exists on which clusters of symptoms are geriatric syndromes, agreement exists that they are syndromes that involve multiple systems and diagnoses.

Which question(s) should you ask to assess medication use in the older adult living in the community? Select all that apply. A. "What medications are you taking?" B. "What is the schedule for your medications?" C. "Which medications are causing side effects?" D. "What is the dose of the medication that you take?"

All of the above Rationale: All of the above. It is best to have the patient demonstrate how they take medications. The nurse can see which medications the patient is taking correctly, those that they might be skipping, and those that they might be taking too much. Polypharmacy is an issue with older adults, and medication deprescribing of unnecessary medications is an option.

How do many older adults define their health? A. Ability to work B. Ability to function independently C. Ability to perform activities related to their hobbies D. Ability to maintain normal food intake

B. Ability to function independently Many older adults define their health by their ability to perform self-care, which health care providers identify as functional abilities. Functional ability in an older adult can vary widely during his or her later years.

A group of students is reviewing information about the frail elderly and functional status. The students demonstrate understanding when they identify which as an instrumental activity of daily living? A. Bathing B. Cooking C. Toileting D. Eating

B. Cooking Instrumental activities of daily living focus primarily on household chores (e.g., cooking, cleaning, laundry), mobility-related activities (e.g., shopping and transportation), and cognitive abilities (money management, using the telephone, and ability to make decisions affecting basic safety and social needs). Examples of activities of daily living (ADLs) include bathing, eating, grooming, and toileting activities.

As part of the MMSE, you ask the patient to immediately state three words. This is a measure of which of the following? A. Orientation B. Registration C. Recall D. Attention

B. Registration Rationale: Registration indicates that the brain has processed the information and that the patient has heard the information correctly. Recall is the ability to remember it at a later time. Orientation includes time, place, person, and situation. Attention is the ability to follow a flow of conversation.

A neurologic change associated with normal aging is A. loss of long-term memory. B. a decrease in reaction time. C. swaying or shuffling gait. D. a significant decline in judgment and cognition.

B. a decrease in reaction time. Poor lower body strength, especially in the ankles, may impair the ability of the frail older adult to rise from a chair to a standing position. Poor upper body strength, especially in the shoulders, may impede the ability to push up from a bed or chair or to extend and flex fingers.

The nurse notes that an older client has a systolic murmur. What should this finding suggest to the nurse? A. onset of heart failure B. calcification of the aortic cusps C. hypertrophy of the left ventricle D. malfunction of the right atrium

B. calcification of the aortic cusps Middle-aged and older adults commonly have a systolic aortic murmur. With aging, fibrotic changes thicken the bases of the aortic cusps. Calcification follows, resulting in audible vibrations. Turbulence produced by blood flow into a dilated aorta may further augment this murmur. An S3 heart sound may indicate the onset of heart failure. Displacement of the point of maximum impulse would be associated with hypertrophy of the left ventricle. An atrial arrhythmia would indicate malfunctioning of the right atrium.

A sign of infection in the elder that is more common than fever is A. pain. B. confusion. C. diarrhea. D. cough.

B. confusion. Confusion is often a sign of infection in the frail older adult.

Nutritional screening is an assessment of risk factors that A. indicate that the patient is at high nutritional risk for obesity. B. identify older adults who may require a more comprehensive assessment. C. calculate BMI and classify patients as obese versus malnourished. D. describe food frequency and microelements that may be lacking in the diet.

B. identify older adults who may require a more comprehensive assessment. Rationale: Nutritional screens are used for both undernutrition and overweight. The screen includes not only objective measures such as BMI but also social variables like eating along. The food frequency questionnaire is used for specific intake, such as folate in pregnancy.

The patient has findings of cognitive decline, minimal to no intake of nutrition, and neglect of the home environment and finances. Which of the following is the appropriate nursing diagnosis? A. Sensory deficit B. Impaired skin integrity C. Impaired nutritional intake D. Adult failure to thrive

D. Adult failure to thrive Rationale: All of these findings may be included in adult failure to thrive. Sensory deficits commonly include hearing and vision. Nutritional intake places older adults at risk for skin breakdown, weakness, and impaired healing. Impaired skin integrity is a separate condition that needs collaborative treatment and is separately treated.

An older client admits that she has recently begun wetting her pants. On further questioning by the nurse regarding the cause of the incontinence, the client explains, "I move so slowly these days that I can't always make it to a bathroom in time." The nurse recognizes this as which type of incontinence? A. Stress B. Urge C. Overflow D. Functional

D. Functional Functional incontinence is the inability to get to the bathroom in time or to understand the cues to void due to problems with mobility or cognition. Urge incontinence is the involuntary loss of urine associated with an abrupt and strong desire to void. Stress incontinence involves involuntary loss of urine when coughing, sneezing, or laughing. Overflow incontinence is the condition in which the client has involuntary loss of urine associated with overdistention of the bladder.

When speaking with a frail older adult, it is best to A. fill in silences to avoid discomfort. B. address all questions to the patient's family. C. rely on the patient's memory when gathering all information. D. ask questions using lay terms rather than medical terms.

D. ask questions using lay terms rather than medical terms. Rationale: The older adult needs more time to answer questions. It is best to talk directly with the patient and use the family as a resource as needed. Information from the chart can be validated with the patient, but it is best to gather information ahead of time to avoid asking unnecessary questions and fatiguing the patient. Allow silence to allow time for processing of questions, and respect the patient by directly giving them an opportunity to answer rather than going straight to the family.