Older Adult Prep-U

An older adult client comes to the clinic for a follow-up evaluation. During the visit, the client tells the nurse about "having trouble sleeping lately." Which question should the nurse ask to obtain more detailed assessment information to develop a plan of care?

"Do you use nicotine, alcohol or caffeine?"

An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address?

"I find myself napping on and off throughout the day."

A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states:

"I need to try and go to bed and get up at the same time each night."

A 78-year-old client asks the nurse about the using ibuprofen for relief of his joint pain. Which response by the nurse would be most appropriate?

"It's okay for you to take it once in a while but if you need it often, we'll talk with your doctor about adding another medication." "Sure, it's fine. The drug is available over-the-counter and it's very good at relieving pain." "Absolutely not. Because of your age, you have a very high risk for bleeding with the drug even if you take it only once or twice." "You really should try aspirin instead of ibuprofen. There are less risks associated with it."

An older adult client comes to the clinic for a follow-up evaluation. During the visit, the client tells the nurse that he's "been having trouble sleeping lately." After educating the client on measures to promote good sleep habits, the nurse determines that the client needs additional education when he states: "The sleeping medication takes about a month before it starts working." "I need to keep the bedroom cool and quiet when I go to sleep." "I should avoid exercising for about 3 to 4 hours before bedtime." "I should try to go to bed at about the same time each night."

"The sleeping medication takes about a month before it starts working." "I need to keep the bedroom cool and quiet when I go to sleep." "I should avoid exercising for about 3 to 4 hours before bedtime." "I should try to go to bed at about the same time each night." Rationale: Sleep medications may be used, but these drugs are most effective when limited to short-term use (7-14 days) or the medications may actually interfere with sleep.

The staff at a long-term care facility have made minimal effort to secure a shared room for a couple in their late 80s, who have been married for several decades. The manager states, "I'm sure that bedroom activity is the last thing on their mind these days." How should the nurse best respond to the manager's characterization of sexuality in older adults?

"They might not be as active as in years past, but sexuality is still important for older people."

x The staff at a long-term care facility have made minimal effort to secure a shared room for a couple in their late 80s, who have been married for several decades. The manager states, "I'm sure that bedroom activity is the last thing on their mind these days." How should the nurse best respond to the manager's characterization of sexuality in older adults?

"They might not be as active as in years past, but sexuality is still important for older people."

The home health nurse is making an initial home visit to a client aged 76 years. During the assessment the nurse finds that the client takes multiple medications. The client states also taking some herbal remedies. Which statement is more likely to help the nurse obtain information to determine if unhealthy interactions between the medications and herbal remedies may be occurring?

"What type of herbal remedies have you been taking?"

A home care nurse is caring for a client who lost the spouse to cancer 3 years ago. What question would the nurse ask to facilitate a life review?

"Would you tell me about your life when you first met your spouse?"

A nurse is assessing an older adult using the short form of the geriatric depression scale. The nurse determines that the client is depressed based on which score?

6 A score greater than 5 on the short form of the geriatric depression scale suggests depression.

A nurse is assessing an older adult for depression using the Yesavage Geriatric Depression Scale. Which score would the nurse identify as indicating possible depression?

6 Rationale: A score of 5 points or more with the Yesavage Geriatric Depression Scale indicates probable depression.

A nurse is participating in a health fair for older adults. The nurse would recommend routine screenings for which conditions for this population? Select all that apply.

Breast cancer Colorectal cancer Osteoporosis Diabetes

A nurse is preparing to medicate an older adult client with an opioid analgesic. Which of the following does the nurse consider in the use of this medication?

Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when pain is not managed adequately Pain is a normal consequence of aging. Older adults are frequently prescribed higher doses of opioid analgesics than younger adults. Pain is often experienced by older adults and is usually adequately treated.

A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client?

Depression

Medicare will no longer reimburse the hospital for certain adverse events, including in-hospital falls. Fall prevention is a major part of nursing and risk management. In order to reduce the risk of falling, the nurse must do which of the following? Select all that apply.

Ensure that the client wears his prescription glasses when up. Post signs to alert staff to the client at high risk for falls. Assess the client's fatigue level. Monitor gait and balance.

An older adult client comes to the senior center for a check-up. During the visit, the client tells the nurse that he knows he should be more active than he is. The nurse reinforces the client's statement, explaining that physical activity helps to lower the risk of which condition? Select all that apply.

Heart disease Stroke Diabetes

The nurse is reminiscing with a 72-year-old client with early onset dementia while providing care in a long-term care facility. How does the nurse implement this form of therapy to maximize the therapeutic value?

Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship.

A nurse is preparing a presentation for families who are caring for older adults at home. Which information would the nurse most likely include about an older adult's cognition?

Many older adults retain full cognitive function into advanced age.

A older adult client is admitted to a nurse's unit with a community-acquired pneumonia requiring 14 days of intravenous antibiotic treatment. What does the nurse identify to the client as a contributing factor that affects the older adult client?

Older adults are more susceptible to pneumonia following respiratory infections. Humoral immunity declines.

An older adult client is prescribed antipsychotic therapy. The nurse understands that this therapy has been initiated based on?

Other strategies have failed. There is a risk of harm to self or others. The client is displaying psychotic behavior. The client needs less-intensive treatment. The client is exhibiting signs of depression.

A nurse documents "dry, thin skin with several areas of ecchymoses" on an older adult client's chart. Which nursing diagnosis would be appropriate for this client?

Risk for injury

An older adult is prescribed spironolactone. The nurse would expect to monitor which laboratory test result closely?

Serum potassium The risk of hyperkalemia is higher in older adults, especially if the client is taking more than 25 milligrams per day or taking concomitant NSAID, angiotensin converting-enzyme inhibitor, angiotensin receptor blocker, or potassium supplement.

An older adult who is newly widowed is not adjusting to this change in her role. She is unable to form new relationships. What is the client at risk for developing?

Social isolation

A nurse is reviewing several journal articles about the mistreatment of the older adult. Which condition would the nurse expect to find as a risk factor? Select all that apply.

Social isolation Dementia Frailty

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence?

Stress Urge Overflow Functional

An older adult client comes to the senior center for a check-up. During the visit, the client tells the nurse that he knows he should be more active than he is. The nurse reinforces the client's statement, explaining that physical activity helps to lower the risk of?

Stroke Diabetes Heart disease

A nurse at a long-term care facility is working to develop a program to promote regular medical check-ups for the residents in order to minimize the risk of infection. When proposing this program to the facility's governing board, which statement would the nurse emphasize as the underlying rationale for this type of program?

The antibody response in older adults is lower, placing them at increased risk.

After obtaining the health history from an older adult client, the nurse develops a plan of care and identifies the client has impaired physical mobility. What information would support this impairment? Select all that apply.

The client states the hip and knee joints hurt and are stiff when ambulating. The client states that he or she must use a walker for stability. The client reports weakness on one side of the body following a stroke.

A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as:

abandonment. exploitation. neglect. emotional abuse. Rationale: The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion or a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult.

Family members of older adults with limitations from chronic illnesses may experience multiple stressors. Which is not considered one of these stressors?

feeling valued, useful, and productive

A nurse is providing care to an older adult who is experiencing delirium. Which risk factors would the nurse identify as being most common?

pre-existing cognitive impairment advanced age sleep deprivation Rationale: Formation of amyloid plaques and tangles of tau proteins have an impact on the brain structure and function in older adults with dementia and not delirium. A previous MI is not a risk factor for the the development of delirium.

A nurse is preparing for a discussion with a group of older adults about the need for adequate nutrition. Which factor would the nurse address as placing an older adult at risk for decreased food intake? Select all that apply.

reduced thirst sensation early satiety reduced level of physical activity decreased number of taste buds

An older adult client being cared for at home has developed a decubitus (pressure ulcer) injury. The nurse would instruct the family caregiver to institute measures to:

relieve sustained pressure

An older adult client being cared for at home has developed a decubitus injury. The nurse would instruct the family caregiver to institute measures to:

relieve sustained pressure.

A 72 year old client often actively engages in reminiscence when the nurse is delivering care. The nurse recognizes that:

reminiscence is a normal process in achieving ego integrity. reminiscence should be discouraged until the client is discharged. reminiscence interferes with the client's ability to accept death. reminiscence occurs when a client withdraws from usual roles. Rationale: Reminiscence is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Nurses can use reminiscence as a therapy to facilitate adaptation to present circumstances. It does not have to do with the client's feelings about death. Withdrawing from usual roles is termed disengagement.

The nurse is caring for an older adult client post surgery in the critical care unit. The nurse finds that the client is acutely confused and trying to get out of bed. Which is the priority nursing intervention?

review with the client that he or she is in the hospital

A client aged 88 years who lives alone has deficits in vision and hearing, although these deficits are corrected by glasses and hearing aids. The client's blood pressure medicine is causing dizziness. What response to these health problems would the home health nurse identify?

risk for accidental injury risk for decreased social interaction risk for impaired judgment altered consciousness

A nurse is developing a plan of care for a client who recently lost his spouse. Which of the following would be most appropriate for the nurse to suggest to help the client cope with his loss?

seeking support from his faith remaining active in the community maintaining nutritional intake validating his needs Rationale: Social support and therapy are other methods of adaptive coping. Remaining active in the community fosters social connection, the client may find it difficult to do so. Remaining active does aid in addressing loneliness. Maintaining nutrition promotes the health of the older adult but does not affect coping. Validating his needs is a treatment strategy used with clients experiencing dementia.

The nurse is assessing an older adult client who is having difficulty with mobility. Assessment reveals that the client has stiff and awkward muscle movements. The nurse identifies this as:

spasticity.

An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for:

suicidal thoughts. lack of initiative. poor cognitive performance. sleep problems. Rationale: All other options are manifestations of depression

Based on an understanding of the cognitive changes that normally occur with aging, what might the nurse expect a newly hospitalized older adult to do?

take longer to respond and react

The nurse is assigned to a 52-year-old client. The client is talkative and usually friendly when the nurse enters the room. Today, however, the client is standing at the mirror and says: "I lost my job because the company downsized; there isn't anything I can do." The nurse recognizes this expression of concern is related to:

the client's compromised career goals and retirement plans.

The nurse is assigned to a 52-year-old client. The client is talkative and usually friendly when the nurse enters the room. Today, however, the client is standing at the mirror and says: "I lost my job because the company downsized; there isn't anything I can do." The nurse recognizes this expression of concern is related to:

the client's compromised career goals and retirement plans. the client being in an androgenic crisis. the client assuming the termination is his or her fault. that there is dissatisfaction with changes in appearance and energy levels.

A client aged 88 years who lives alone experiences dizziness caused by blood pressure medication. What intervention would the nurse prioritize in teaching this client?

Change positions slowly.

What term is used to describe various disorders that progressively affect cognitive function?

Dementia

A 78-year-old woman is on a nurse's rehabilitation unit status post a cerebrovascular accident (CVA). As the nurse assess her gait, the nurse notices that the client's left foot is dragging and she is not bending her left knee nor swinging her left arm. How would the nurse best describe the client's gait?

Hemiparesis

A nurse is working with an older adult population at a local community senior center. Based on information from the Association of Aging, the nurse would anticipate needing to address which condition as most common?

Hypertension

The nurse is caring for an older adult postsurgical client who will be immobile for several weeks. Which evidence prompts the nurse to monitor for a risk for infection?

Increased white blood cell count on laboratory results

Which statement is true for nursing care of older adults?

Most older adults are functional, benefiting from health-oriented interventions. Most older adults are unable to care for themselves independently. Fewer older adults will require nursing care during the 21st century. Interventions for older adults are no different from those for young adults.

A nurse is preparing a presentation for a group of older adults about health promotion. Which statistic would the nurse need to keep in mind about this group?

The group experiencing the largest growth is those 85 years of age and older.

When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply.

decline in humoral immunity lowered antibody responses inadequate nutrition

A nurse is preparing a presentation for a group of families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease:

doubles every 5 years.

A nurse is reviewing the medical records of clients at a long-term care facility who are experiencing weight loss. The clients' medical conditions have been ruled out as a cause. The nurse understands that which situation would most likely be a factor? Select all that apply.

evidence of depression use of appetite-suppressing drugs need for staff to assist with meals