Prep U - Foundations of Gerontology and Theories of Aging

The gerontological nurse overhears another nurse state, "It's too bad people become mean as they age." What is the gerontological nurse's best response?

"Actually, theory suggests personalities are consistent throughout life." Explanation: According to the continuity theory of aging, personality and basic patterns of behavior are said to remain unchanged as the individual ages. Older adults have varied personalities. Generational differences and clients' frustrations can affect communication, but these factors do not support a generalization of "mean" behavior among older adults.

A nurse is teaching an older person about the concept of successful aging. Which of the nurse's questions addresses an important contributor to successful aging?

"Are you able to engage in activities of daily living, including social activities?" Explanation: Research has indicated that an active engagement with life is central to successful and healthy aging. Absence of illness, financial security, and the nature of a person's support network are not identified components of successful aging.

The son of an older adult female client asks the nurse why the staff bothers his mother so much to go to the bathroom during the day. What is the nurse's best response?

"Bladder capacity decreases with age, hence the need for frequent toileting." Explanation: The best response is to explain that bladder capacity decreases with age. More frequent trips for toileting can prevent urinary stasis and urinary tract infections. Incontinence itself is not a normal outcome of aging, however many women may experience stress incontinence due to weakening of the pelvic diaphragm. While physical activity and mobility are encouraged, the primary reason for frequent toileting is to prevent urinary stasis and complications. Frequent toileting has several benefits, not only reducing the possibility of relying on diapers.

A diabetes nurse is providing care for an older adult client who is a regular client of the hospital's outpatient diabetes clinic. What assessment question most clearly addresses this client's potential for optimal function?

"What are some goals that you have for maximizing your level of wellness?" Explanation: Eliciting an older adult's goals for wellness and high functioning can help promote these outcomes. Questions about a client's living situation, disease management, and personal responsibility may or may not promote wellness.

A 75-year-old female asks to talk to the nurse about how to maintain safe and satisfying sexual relationships. What is the nurse's best response?

"Water-based lubricants are helpful for relieving vaginal dryness." Explanation: A dry vaginal canal is a common physiological finding in older women. There is no indication in the question that this female has an arousal problem. Sex is not contraindicated at age 75 as long as the person is reasonably healthy. Condoms reduce the risk of sexually transmitted infections in older aged persons as well as middle and young aged persons.

Which older adult is most likely to have experienced the death of a spouse?

83-year-old female Explanation: Most woment will be widowed by the time they reach their eighth decade of life. The death of a spouse affects more women than men because women tend to have a longer life expectancy than men.

The nurse learns that within the last 6 months an older client has experienced pneumonia, a skin infection, and a urinary tract infection. Which theory of aging might help explain why this client is experiencing an increase in infections?

Autoimmune reaction Explanation: In the autoimmune reaction theory of aging, immune response declines after young adulthood. The weight of the thymus decreases throughout adulthood, as does the ability to produce T-cell differentiation. The reduction in immunologic functions is evidenced by an increase in the incidence of infections with age. The nutrition theory of aging explains a relationship between the quality of nutrition and aging. This theory does not explain why an increase in infections occurs. The radiation theory of aging focuses on the effects of radiation on the skin and the development of skin cancers. The neuroendocrine theory of aging suggests that aging is the result of changes in the brain and endocrine glands. This theory does not explain the increase in the client's number of infections.

The nurse should include which important safety tip when teaching an older adult about the effects of decreased sensitivity of baroreceptors?

Change positions slowly Explanation: Reduced sensitivity of the blood-pressure regulating baroreceptors increases problems with postural hypotension, so the older adult should be taught to change positions slowly. Postprandial hypotension can occur within one hour after meals, so this is not the best time for exercising. Postural or orthostatic hypotension is checked while patient is in the lying, sitting, and standing positions. Baroreceptors monitor blood pressure, not hydration status.

During a head to toe examination, the nurse should expect which musculoskeletal finding in the older adult?

Decreased grip strength Explanation: Reflexes are lessened in the arms, but are maintained in the knee. Overall muscle strength, and muscle movement, are decreased. Muscle tremors may be present but are not present in all older adults.

How can the gerontologic nurse best advocate for older adult benefits?

Endorse cost-containment efforts that maximize welfare of older adults. Explanation: Gerontological nurses need to be advocates in ensuring that cost-containment efforts do not jeopardize the welfare of older adults. Spending limits and tax dollar limitations may jeopardize the welfare of older adults if needed services are cut. Open discussion and problem-solving are needed to address the concern of continuting benefits for older adults.

The nurse recognizes which statement is true about older adults?

Functional age describes physical, psychological and social aspects of aging. Explanation: Chronological age defines the year a person has lived since birth. Perceived age is another term that is used to describe how people estimate a persons age based on appearance. Age identity describes how people feel or perceive their own.

An 68-year-old female tells the nurse she has found a topical product that claims to stop the aging process and eliminate the appearance of wrinkles. What is the nurse's best response?

Help the client critically evaluate the product's claims. Explanation: It's beneficial for nurses to advise aging persons to scrutinize products that claim to cause, stop, or reverse the aging process. Applying the cream as directed, cleansing the skin, and reporting burning or itching are appropriate actions after notifying the primary care provider.

An older adult who appears thin and emaciated with little subcutaneous fat is admitted to the geriatric unit. What is the priority safety concern for this client?

Increased chance of hypothermia Explanation: The loss of subcutaneous fat in older adults is responsible for a decline in skin-fold thickness and natural insulation, making older adults more sensitive to cold temperatures. Hypothermia is the priority concern that can cause the most adverse effects. Stature decreases due to reduced hydration, loss of cartilage, and thinning of the vertebrae. Decreased bone mass occurs due to changes at the cellular level and is not affected by loss of fat.

An older male client states he is satisfied with his life accomplishments. According to Erikson's theory, what developmental task has this client achieved?

Integrity Explanation: Erikson's theory suggests that the older adult developmental task is achievement of Integrity versus Despair. Industry is the developmental task of middle childhood. Autonomy is the developmental task of toddlers. Identity is the developmental task of adolescence.

What is the most appropriate teaching point to include in an older adult's plan of care?

Keep appointments for cancer screenings. Explanation: The reduction in immunologic function is evidenced by an increase in the incidence of infections and many cancers with age. Flu vaccines and appointments for cancer screenings are appropriate recommendations to prevent complications from decreased immunologic function. Daily antibiotics and routine genetic testing are not routinely recommended interventions for most clients.

An 80-year-old widower experiences loneliness because his children and grandchildren live three states away. What suggestions could the nurse make to pass the time? Select all that apply.

Local religious activities Journaling Scrapbooking Arts and crafts activities Explanation: Nurses can suggest self-reflective activities to document one's life story such as scrapbooking, journaling, arts and craft activities. Such tangible items may serve as an assurance to both young and old that the impact of an aged relative's life will not cease at death. Participating in local church activities can establish a support system for this man. Moving to a nursing home is not the best suggestion as it involves a financial investment and may suppress independence.

An older adult on a fixed income requires a walker and transportation to therapy two days a week after knee replacement surgery. The nurse should help ensure the client has which type of insurance coverage to cover these services?

Medicare part B Medicare Part B assists with durable medical equipment such as walkers, and also may cover limited transportation for the client. Medicare part A covers hospital and physician services. Part D is prescription drug coverage. Medicare part C or Advantage provides the option to purchase private insurance plans; however this client is on a fixed income and likely can not afford private coverage.

An expensive anti-hypertensive medication is prescribed for an older adult. The gerontological nurse should suggest the client apply for which type of insurance coverage to cover the cost of medication?

Medicare part D Explanation: Medicare part D is also known as a Medicare Advantage Prescription Drug Plan. Part A covers hospital and physician services. Part B covers physician and nursing services, as well as some durable medical equipment. Social security is a benefit check paid to persons over 65 and/or persons with disabilities.

An older client who is nondiabetic has a reported glucose level of 126 mg/dL (7.0 mmol/L). What is the nurse's best action?

Monitor for signs of hyperglycemia. Explanation: Higher blood glucose levels than are normal in the general adult population are not unusual in nondiabetic older people. Therefore the nurse should simply monitor the client. This glucose level is higher than normal, not low, so neither dextrose nor orange juice should be given. An IV infusion of normal saline is not necessary for this mildly elevated glucose level.

The experienced gerontological nurse should provide further teaching when a new nurse makes which statement?

Most baby boomers did not have children and do not have much support. Explanation: Most baby boomers have children; however, they had fewer children that can assist them in old age. The impact of the baby boomer generation is often referred to as the demographic tidal wave. They are enamored with "high-tech" products and use computers. They tend to exercise more frequently than other older adults.

Which is a true statement regarding healthcare and long-term care spending for older adults?

Most of the Medicaid budget is spent on long-term care. Explanation: Most of the Medicaid budget is spent on long-term care. In this era of budget deficits and shrinking revenue, the government may not be able to provide a wide range of services for older adults. The average length of hospital stays increases with age.

When reviewing theories of aging, the nurse should recognize which accurate explanation?

No single known factor causes or prevents the aging process. Explanation: No single known factor causes or prevents aging. One theory cannot explain the complexities of aging. Some interest in the aging process focuses on achieving eternal youth, but sound research aims to gain a better understanding of the aging process itself. Understanding the aging process only serves to possibly postpone some of the negative consequences of aging.

What is the priority safety recommendation the nurse should make for the older adult in regards to changes in the respiratory system?

Pneumococcoal vaccination Explanation: With less effective gas exchange, lack of basilar infiltration, and less mobility, older adults are at higher risk for developing respiratory infections such as pneumonia. Breathing dry air does not normally pose a safety risk, and use of decongestants can cause rebound congestion. Increased physical activity and exertion are beneficial to respiratory health unless the older adult has a specific contraindication to exercise.

An older male client reports a recent history of urinary frequency. After collecting a urine specimen, what is the nurse's next action?

Prepare for prostate examination. Explanation: Prostatic enlargement occurs in most older men. Three-fourths of men aged 65 years and older have some degree of prostatism, which causes problems with urinary frequency. Most prostatic enlargement is benign. Antibiotics will not be prescribed unless an infection is diagnosed after examination.

What is the best nursing action to combat the effects of a less functional hypothalmus in older adults?

Regulate the room temperature. Explanation: The hypothalmus regulates temperature less effectively in old age, and adjusting to temperature extremes is difficult for the older adult. Toileting, hearing deficits, and slower information processing are not direct results of a less effective hypothalmus.

An older client who retired from a position that was held for 45 years plays golf every Wednesday, swims with the "guys" on Tuesdays and Thursdays, and has a "date night" with his spouse every Saturday. Which phase of retirement does the nurse realize this client is demonstrating?

Routine Explanation: The client who plans routine activities and involvement demonstrates the retirement routine phase. The retirement phase is when the person is in the "honeymoon period" and activities that the person never had time to complete while employed are completed. The reorientation phase is when realistic choices and alternative sources of satisfaction are considered. The disenchantment phase is when the person experiences a letdown or depression because the preretirement fantasy has not materialized.

A grandmother from the baby boomer generation is planning to retire soon and expresses to a nurse concern over taking care of her grandchildren. Her daughter has assumed she would be saving in daycare costs because her mother is retiring and can take care of the children. What discussion topic should the nurse prioritize with the grandmother?

The grandmother's desire to keep working part-time Explanation: Most baby boomers are expressing a desire and need to continue working as they enter retirement age. There is no indication that assisted living is necessary and there are not major legal implications when providing occasional care for grandchildren. There is not enough information to characterize the daughter's desire as being manipulative.

The nurse knows that which statement is accurate about the subsets of the older adult population today?

The healthcare challenges of the young-old and old-old groups can vary greatly. Explanation: It is now recognized that much diversity exists between different age groups in late life. The interests and healthcare challenges of each of these subsets can be vastly different. Standardized care plans do not permit for the varied interests and healthcare challenges of the subsets in the older adult population.

Which statement made by a gerontological nurse to a new graduate nurse is most accurate?

The healthcare system is currently greatly impacted by the aging of baby boomers. Explanation: The older population is growing at a fast rate today due to the impact of the aging baby boomers. Most people are achieving and spending longer periods of time in old age today. Most older adults live in a home with a spouse or a family member.

A new gerontology nurse correctly utilizes the evolutionary theory of aging when making which statement?

The processes of mutation and natural selection are highly significant Explanation: The evolutionary theory suggests that mutation and natural selection are major influences on the aging process. The biogerontology theory suggests persons live longer due to vaccination and immunization. Genetic theories address gene mutation changes and the effects on aging but do not have an emphasis on natural selection. Autoimmune reaction theories of aging emphasize the effects of the thymus and bone marrow on immunity and longevity.

What factor should the nurse consider when planning care for older minority clients?

These clients may have lower-than-average levels of health and function. Explanation: Today's older minority populations have been shown to have lower levels of health and function than white Americans. This is associated with lower levels of wellness. Therefore, nurses must diligently assess for discrepancies in care such as not being able to afford medications and other treatments.

An older adult has begun writing paragraphs about significant events and the year they occurred. Which activity is this older adult creating?

Time Line Explanation: A time line consists of writing about significant events on or near the year when they occurred. The tree of life method of eliciting life stories involves writing about significant events from the past that are branched off from the tree. A life map records events on a map. Obtaining an oral history involves asking the older adult to record their spoken stories of life.

An older client requiring total knee replacement surgery responds that it was "just a matter of time" since most body parts "wear out" when growing old. Which theory of aging does the nurse realize this client is describing?

Wear and Tear Explanation: Wear and tear theories attribute aging to the repeated use and injury of the body over time as it performs its highly specialized functions. Like any complicated machine, the body will function less efficiently with prolonged use and numerous insults. Evolutionary theories of aging are related to genetics and hypothesize that the differences in the aging process and longevity of various species occur due to interplay between the processes of mutation and natural selection. The cross-linking theory proposes that cellular division is threatened as a result of radiation or a chemical reaction in which a cross-linking agent attaches itself to a DNA strand and prevents normal parting of the strands during mitosis. Over time, as these cross-linking agents accumulate, they form dense aggregates that impede intracellular transport; ultimately, the body's organs and systems fail. Biogerontology is the study of the connection between aging and disease processes. In this theory, the control of pathogens slows the body's decline with aging.

The family believes that an older client should move to an assisted living facility that promotes the activity theory of aging. What should the client expect if relocating to this facility?

Weekly trips to the local shopping mall Explanation: Weekly trips to the local shopping mall promotes socialization and activity engaged in during middle age. Exposure to therapy pets promotes sensory stimulation and does not necessarily support a particular theory of aging. Gradual disengagement with societal functions and taking meals in isolation supports the disengagement theory of aging.

An older client's daughter is concerned because her father has disengaged from the mainstream of society. What is the nurse's best response?

What factors have caused you to be concerned? Explanation: The nurse should first assess the factors that are causing the daughter's concern. Disengagement is not necessarily a process to be expected from all aged persons. Societal norms are changing everywhere, so moving is probably not a feasible solution.

An 88-year-old male with recent muscle weakness reports eating fish four times a week. What is the nurse's best assessment question?

What type of fish do you usually eat? Explanation: Environmental factors such as ingestion of mercury (which can be found in fish) can produce pathologic changes in human beings. Omega fatty acids are good for heart health, but determining the type of fish consumed is important for figuring out how much mercury may be ingested. The restaurant location is irrelevant. Salt can contribute to high blood pressure, but the chief concern in this case is determining mercury intake because of the stated fish intake.

An 85 year old male state he is anxious to get back on the golf course once the weather permits. What is the nurse's best response?

Where is your favorite golf course? Explanation: More people are achieving and spending longer periods of time in old age than ever before. Golfing at age 85 is not unusual. The nurse should be supportive of physical activity in old age. The nurse should not imply that the client needs his children's permission to play golf.

When reviewing the demographic data in a new 74-year-old female client's chart, what finding is most likely?

Widowed for 3 years Explanation: More than half of women older than 65 years are widowed. Most older adults live in homes with spouses or with family members. Women are more likely to marry older men, therefore being widowed is a higher probability then being divorced. There has been little change in the low labor force participation of women 65 years of age and older.

A nurse identifies clients who are at risk for familial stress. Which client exemplifies the sandwich generation?

a 50-year-old who balances the care of an 82-year-old parent and a 17-year-old child Explanation: The increasing numbers of middle-aged adults who simultaneously juggle the demands of caring for older and younger generations are referred to as the sandwich generation.

An older adult has recently begun to display unprecedented lapses in short-term memory. The nurse overhears a colleague reassuring the person by saying, "Try not to worry; it's just a part of growing older." This is an example of which phenomenon?

age attribution Explanation: Age attribution is the act of attributing a problem to age rather than to a pathology, as in the colleague's statement. Multiple jeopardy is the compounding of discrimination based on factors such as race and gender, while gerontophobia is the fear or hatred of older people. Implicit ageism is the unrecognized, negative perception of older people.