Prep U's - Chapter 8 - Management of the Older Adult Patient

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to: A. Ingest five or six small meals each day. B. Minimize the use of stool softeners. C. Use whirlpool baths for relaxation. D. Take daily hot showers.

Answer: A Rationale: A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.

The nurse is describing hospice services to the family of a patient with end-stage heart failure. Which of the following would the nurse be least likely to include as a major focus of care? A. Invasive therapy. B. Emotional support. C. Symptom management. D. Pain control.

Answer: A Rationale: The goal of hospice is to improve the patient's quality of life by focusing on symptom management, pain control, and emotional support.

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. A. Participating in regular exercise. B. Ensuring appropriate fluid intake. C. Avoiding all sun exposure. D. Avoiding environmental smoke. E. Following a high-calcium diet.

Answer: A, B, D Rationale: Activities that help elderly clients maintain good respiratory function include avoiding environmental smoke, regularly exercising, and ensuring appropriate fluid intake. Sun exposure and a high-calcium diet are health-promotion strategies for the integumentary and musculoskeletal systems respectively.

An older adult female patient informs the nurse that she is sexually active but has a problem with vaginal dryness. What can the nurse tell the patient that may help relieve this problem? A. Use a water-based lubricant with sexual intercourse. B. Find other methods of sexual expression. C. Use vaginal douche daily. D. Use an over-the-counter antifungal cream to treat the fungal infection she probably has.

Answer: A Rationale: Changes that occur in the female reproductive system include thinning of the vaginal wall, along with a shortening of the vagina and a loss of elasticity; decreased vaginal secretions, resulting in vaginal dryness, itching, and decreased acidity; involution (atrophy) of the uterus and ovaries; and decreased pubococcygeal muscle tone, resulting in a relaxed vagina and perineum. Without the use of water-soluble lubricants, these changes may contribute to vaginal bleeding and painful intercourse. Use of a vaginal douche daily would not improve vaginal dryness. The vaginal dryness is not associated with a fungal infection. There is no need for the woman to find another method of sexual expression.

When assessing an older adult, the nurse anticipates an increase in which component of respiratory status? A. Gas exchange and diffusing capacity. B. Cough efficiency. C. Vital capacity. D. Residual lung volume.

Answer: D Rationale: With an increase in residual lung volume the client experiences fatigue and breathlessness with sustained activity. The nurse anticipates decreased vital capacity. The nurse anticipates decreased gas exchange and diffusing capacity resulting in impaired healing of tissues due to decreased oxygenation. The nurse anticipates difficulty coughing up secretions due to decreased cough efficiency.

An older client seeks medical attention for injuries caused by a fall. What education will the nurse provide for this client? A. "Ensure proper footwear is worn at all times." B. "Move to a new residence to avoid repeated falls." C. "Stop taking medications if they make you dizzy." D. "Use throw rugs in your home for added traction."

Answer: A Rationale: Accidental injuries rank third as a cause of death for older people, and falls are the most common cause of nonfatal injuries and hospital admissions. Improper or unsafe footwear can contribute to falls, and education should be provided to this client to ensure proper footwear is worn at all times. The nurse should not advise the client to stop taking medications, but could encourage the client to discuss side effects with their health care provider. Throw rugs are a tripping hazard and should be avoided to prevent falls. Moving to a new residence increases the risk of falls, as older adults do better in familiar environments.

When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? A. Stomach emptying B. Calcium absorption C. Gastric motility D. Feeling of fullness

Answer: D Rationale: In an older adult, gastric motility slows modestly, which results in delayed stomach emptying, which in turn leads to early satiety (feeling of fullness). Calcium absorption is also decreased.

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? A. Cataract B. Presbyopia C. Presbycusis D. Glaucoma

Answer: B Rationale: Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.

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? A. "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." B. "What concerns you most about Alzheimer disease?" C. "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." D. "Alzheimer disease can be a great burden on the family. What community resources do you know about?"

Answer: A Rationale: Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? A. "The drug helps to control the symptoms of the disease." B. "This drug will help to stop the disease from getting worse." C. "Once it becomes effective, you can stop the drug." D. "The client need to take this drug for the rest of his or her life."

Answer: A Rationale: Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

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? A. Encouraging clients to avoid cigarette smoking. B. Assisting clients to soak int he bathtub several times each week. C. Taking the clients outside for sun exposure only. D. Instructing clients to use perfumed skin creams.

Answer: A Rationale: Measures to promote healthy skin function in elderly clients include not smoking. Other measures include avoiding exposure to the sun, using emollient skin cream containing petrolatum or mineral oil, and avoiding hot soaks in the bathtub.

The nurse caring for residents of a long-term care facility is explaining the occurrence of elder abuse in such facilities. Which statement from the nurse indicates the need for more education? A. "Older adults in long-term care facilities are at low risk for elder abuse." B. "Most states requires nurses to report elder abuse." C. "Older adults with disabilities are at increased risk for elder abuse." D. "Limitations to activities of daily living contribute to risk of elder abuse."

Answer: A Rationale: Residence in a long-term care facility does not result in a lower risk for elder abuse. Older adults with disabilities of all types are at increased risk for elder abuse from family members, paid caregivers, and staff, whether they live in the community or a long-term care facility. Most states require caregivers, including nurses, to report elder abuse. Another factor that places older adults at higher risk of abuse is limitations to activities of daily living.

A nurse is presenting a safety program to a group of older adults at a continuing care retirement community. The nurse emphasizes measures to reduce the risk of falls based on the understanding that which type of fracture is the most common? A. Hip B. Femur C. Forearm D. Ankle

Answer: A Rationale: The most common fracture resulting from falls is hip fracture, which is linked to both osteoporosis and the situation that provoked the fall. Many older adults who fall and sustain a hip fracture cannot regain their prefracture ability.

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? A. How old you feel will be determined by your physical and cognitive abilities. B. As an older adult, you will not be able to learn new skills or knowledge. C. Most older adults reside in a long-term care facility. D. A decline in sexual activity is a normal occurrence as you age.

Answer: A Rationale: The physical health and cognitive abilities of older adults are directly related to quality of life and how "old" one really feels. Older adults can maintain healthy sexual activity and are able to learn new skills and knowledge. Of older adults, 90% live in the community, not in long-term care facilities.

An older adult was diagnosed with Alzheimer disease 2 years ago and the disease has progressed at an increasing pace in recent months. The client has lost 7.5 kg (16 pounds) over the past 3 months, leading to a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements. What intervention should the nurse include in this client's plan of care? A. Offer the client only one food item at a time to promote focused eating. B. Arrange for insertion of a gastrostomy tube and initiate enteral feeding. C. Offer the client bland, low-salt foods to limit offensiveness. D. Offer the client rewards for finishing all the food on her tray.

Answer: A Rationale: To avoid any "playing" with food, one dish should be offered at a time. Foods should be familiar and appealing, not bland. Tube feeding is not likely necessary at this time and a reward system is unlikely to be beneficial.

The nurse is assessing an older adult's vision and notes increase in glare, slow pupil reaction, and difficulty focusing on close distances without reading glasses. Which actions will the nurse take based on these findings? Select all that apply. A. Inquire about difficulty seeing at night. B. Assess ability to distinguish colors such as blue and green. C. Provide education on age-related vision changes. D. Ask if the client has been diagnosed with macular degeneration. E. Notify the health care provider immediately.

Answer: A, B, C Rationale: The eyes undergo normal changes from aging including an increase in the amount of glare an older adult experiences, slower and less complete pupil dilation, and difficulty focusing at close distances and the use of reading glasses. The nurse would assess for additional age-related changes in this client, such as the ability to distinguish colors decreasing, particularly blue from green, and difficulty seeing at night. Another appropriate action by the nurse would be to provide client education regarding age-related vision changes and maintaining safety. The assessment of this client reveals normal age-related changes, and there is nothing to indicate this client has any symptoms of macular degeneration; asking if they have been diagnosed with this is inappropriate and would cause the client undo worry about a condition they are not likely to have. Notifying the health care provider immediately is not indicated, as these are normal age-related changes.

An older adult is experiencing bowel changes. She used to have a bowel movement every day, but she is now having one every 3 to 4 days. She also states that the stools are hard. Which of the following assessments would the nurse make? Select all answers that apply. A. Activity level of the client. B. Amount of dietary fiber. C. Caloric intake. D. Quantity of daily fluid intake. E. Use of laxatives.

Answer: A, B, D, E Rationale: Certain factors can predispose clients to constipation: lack of dietary fiber, prolonged use of laxatives, inactivity, and insufficient fluid intake. Caloric intake is not indicated as a factor for constipation.

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. A. Supervising nutritional intake. B. Administering psychoactive drugs. C. Using familiar cues about the environment. D. Keeping the patient awake as much as possible. E. Providing a calm, quiet environment.

Answer: A, C, E Rationale: Appropriate interventions when caring for a patient with delirium include maintaining a calm, quiet environment, supervising and monitoring nutritional and fluid intake, and using familiar environmental cues. Psychoactive drugs should be minimized to reduce the possibility of delirium. Keeping the patient awake as much as possible would lead to sleep deprivation, which would increase the patient's risk for delirium.

Which factor alters urinary elimination patterns in older adults? A. Active lifestyle B. Decreased muscle tone. C. Increased bladder capacity. D. Decreased residual volume.

Answer: B Rationale: Older adults typically have decreased muscle tone related to urinary elimination. Increased residual volume, decreased bladder capacity, and sedentary lifestyle are other factors that alter urinary elimination patterns in the older adult.

A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply. A. screening for hypertension. B. decreased community-based services. C. early detection of elevated cholesterol levels. D. decreased exercise. E. decreased smoking. F. improved nutrition.

Answer: A, C, F Rationale: Most deaths in the United States occur in people 65 years or older, with one-half of these caused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.

The nurse is visiting the home of an adult client. Which action will the nurse take to reduce the client's risk for falling at home? Select all that apply. A. Suggest small area lamps in the rooms. B. Remind client to wear loose clothing around the house. C. Place a small scatter rug in front of the kitchen sink. D. Discuss the advantages of grab bars in the bathroom. E. Recommend contrast colors to mark edges of steps.

Answer: A, D, E Rationale: Nurses can encourage older adults to make lifestyle and environmental changes to prevent falls. Adequate lighting with minimal glare and shadow can be achieved through the use of small area lamps. Contrasting colors can be used to mark the edges of steps. Grab bars by the bathtub, shower, and toilet are useful. Loose clothing can increase the risk of falling. Scatter rugs should be removed as these can slip and cause a fall in the home.

The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? A. Instruct the client to receive at least 1 hour of sun exposure each day. B. Assess the need for pneumococcal and influenza vaccinations. C. Encourage physical activity of 30 minutes following breakfast daily. D. Administer intravenous morphine for report of postoperative pain.

Answer: B Rationale: Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.

An elderly client with heart failure reports constipation that has progressively worsened over the last several months. The client's vital signs are pulse 86 beats per minute, blood pressure 94/56, and respirations 18 breaths per minute. It would be best for the nurse to instruct the client to: A. Increase fluid intake to 3000 mL per day. B. Avoid straining when having a bowel movement. C. Take a laxative, such as milk of magnesia, every day. D. Ingest meals with a slightly higher fat content.

Answer: B Rationale: An elderly client may experience hypotension and needs to avoid straining when having a bowel movement. The client should ingest meals with a higher fiber intake, not fat content. Clients are not to take laxatives every day because they can increase their risk for dependence on laxatives to have a bowel movement. It may be good for clients to increase fluids; however, this client has heart failure and may not be able to increase fluid intake.

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? A. "The client need to take this drug for the rest of his or her life." B. "The drug helps to control the symptoms of the disease." C. "Once it becomes effective, you can stop the drug." D. "This drug will help to stop the disease from getting worse."

Answer: B Rationale: Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? A. "This drug will help to stop the disease from getting worse." B. "The drug helps to control the symptoms of the disease." C. "The client need to take this drug for the rest of his or her life." D. "Once it becomes effective, you can stop the drug."

Answer: B Rationale: Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

A client in a nursing home is diagnosed with Alzheimer's disease and is exhibiting the following symptoms: difficulty with recent and remote memory, apraxia, irritability, depression, restlessness, difficulty swallowing, and occasional incontinence. What stage of Alzheimer's disease should the nurse describe the client? A. late B. middle C. early D. end-stage

Answer: B Rationale: Middle-stage Alzheimer's disease is characterized by the above-listed symptoms as well as communication difficulties, motor disturbances, forgetfulness, and psychosis. This stage lasts 2 to 10 years. Early-stage Alzheimer's disease which lasts 1 to 3 years, is characterized by memory loss, poor judgment and problem-solving, difficulty adapting to new environments and challenges, and agitation or apathy. Late-stage Alzheimer's disease is characterized by the loss of all mental abilities and the ability to care for self. End-stage Alzheimer's disease is characterized by the loss of all voluntary activity.

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? A. Reports that she falls asleep more quickly. B. Complaints about frequently waking up during the night. C. Statements that she rarely takes naps during the day. D. Reports that she has trouble waking up from sleeping.

Answer: B Rationale: Older adults tend to take longer to fall asleep, awaken more frequently and easily, and spend less time in deep sleep. They may experience variations in their normal sleep-wake cycles. Coupled with the lack of quality of sleep at night, napping during the day is a common complaint.

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? A. Separation from others. B. Impaired memory. C. Communication difficulties. D. Personality changes.

Answer: B Rationale: Patients with Alzheimer's disease are at high risk for injury because they have impaired memory and poor judgment. They also exhibit impulsivity, which increases their risk. Maintaining a safe environment takes top priority. Communication difficulties could be the basis for several nursing diagnoses such as impaired verbal communication, powerlessness, and impaired social interaction. Separation from others could lead to social isolation, impaired social interaction, and social isolation. Personality changes may lead to a risk for self- or other directed violence, chronic low self-esteem, and risk for suicide.

A health care team is involved in caring for a client with advanced Alzheimer's disease. During a team conference, a newly hired nurse indicates that she has never cared for a client with advanced Alzheimer's disease. Which key point about the disease should the charge nurse include when teaching this nurse? A. As long as the client receives the ordered medication, special care measures aren't necessary. B. Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment. C. Alzheimer's disease affects memory, so the client doesn't need an explanation before procedures are performed. D. The nursing staff should rely on the family to assist with care because family members know the client best.

Answer: B Rationale: The charge nurse should inform the new nurse that clients with Alzheimer's disease are at high risk for injury because they have impaired memory and poor judgment. Maintaining a safe environment takes top priority. Families are an important part of the client care team; however, they shouldn't be relied upon to deliver care. Family members may take turns sitting with the hospitalized client to help maintain client safety. All procedures should be explained in simple terms that the client can understand. Medications should be administered as ordered; however, they don't typically improve symptoms. Instead, they slow disease progression.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? A. Place the client in a secluded room until calm. B. Distract the client with a familiar object or music. C. Document the inability to assess vital signs due to client's agitation. D. Continue taking the vital signs.

Answer: B Rationale: The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the client or nurse. Placing the client in a secluded room may increase agitation and should not be used in this situation. The nurse should document the inability to assess vital signs and the reason why this should be done after the client's basic needs have been met.

An elderly client, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the client? A. Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered. B. Medicare has a copayment for many of the services it covers. This requires the client to pay a part of the bill. C. Medicare will not pay for the cost of acute-care services so the client will be billed for the services provided. D. Medicare will only pay the cost for acute-care services if the client has a very low income.

Answer: B Rationale: The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.

An older female client is concerned because of experiencing vaginal bleeding after having intercourse. Which response will the nurse make to this client? A. "Intercourse should be avoided at your age." B. "The vaginal tissues are dryer with aging." C. "Testing for a sexually transmitted infection is needed." D. "Bleeding after intercourse results from a thickening of the vaginal walls."

Answer: B Rationale: With aging, changes that occur in the female reproductive system include thinning of the vaginal wall along with a shortening of the vagina and a loss of elasticity; decreased vaginal secretions, resulting in vaginal dryness, itching, and decreased acidity; involution of the uterus and ovaries; and decreased pubococcygeal muscle tone, resulting in a relaxed vagina and perineum. Without the use of water-soluble lubricants, these changes may contribute to vaginal bleeding and painful intercourse. Older adults report that a fairly stable and active sex life is an important quality of life issue. Although the vaginal walls become thinner as women age, this is not associated with bleeding after intercourse.

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply. A. Use scatter rugs on hard wood surfaces. B. Have routine vision and hearing screenings. C. Frequently change the furniture layout in the home. D. Wear nonslip shoes or socks when walking. E. Place grab bars in the shower and tub. F. Review medications routinely for side effects.

Answer: B, D, E, F Rationale: Grab bars in the shower and tub may decrease the chance of a fall on a slippery surface. Visual and hearing issues may contribute to falls. Medication interaction and side effects may increase the risk for falls, so medications should be reviewed. The older adult should wear proper nonskid footwear or socks when walking to help prevent falls. Changing the layout of the furniture in the home may increase the risk for falls because of items being in unfamiliar locations. Scatter rugs should not be used because they increase the risk for falls.

An older adult has experienced several acute illnesses over the past few months. Which assessment finding will the nurse use to identify the reason for the client's frequent illness? A. Participation in weekly card club events. B. Ongoing home renovations. C. Recent weight loss. D. Family members revisiting for a holiday.

Answer: C Rationale: Undernutrition, which can lead to malnutrition, may be a problem for older adults. A recent weight loss may have serious consequences and may affect the older adult's ability to maintain health and fight illness. It is unlikely that the client's home environment, family visits, or recreational activities are causing the client to experience frequent infections.

An older adult female has been widowed for several years. Which statements indicate to the nurse that the client may need to consider a change in living arrangements? Select all that apply. A. "I have coffee with my neighbor every morning." B. "I don't like to cook for myself anymore." C. "I attend religious services twice a week at my church." D. "My granddaughter helps me with my laundry." E. "There is no one to talk to most days of the week."

Answer: B, E Rationale: Many older adults have more than adequate financial resources and good health even until very late in life; therefore, they have many housing options. Many older adults relocate in response to changes in their lives such as retirement or widowhood, a significant deterioration in health, or disability. Older adults may move to retirement facilities or assisted living communities that provide some support, such as meals. These types of facilities will also provide opportunities for socialization. The client would not necessarily want to change current living arrangements if grandchildren are available to assist, or if there is a strong support system with neighbors or faith community.

Nursing students are reviewing statistics related to the older adult population and leading causes of death in this age group. The students demonstrate understanding of this information when they rank the following conditions in the order from highest to lowest. A. COPD. B. Heart disease. C. Cerebrovascular disease. D. Alzheimer's disease. E. Malignant neoplasms. F. Diabetes.

Answer: B, E, C, A, D, F Rationale: According to the National Center for Health Statistics, the leading causes of death in the older adult from highest to lowest are heart diseases, malignant neoplasms, cerebrovascular disease, chronic obstructive pulmonary disease, Alzheimer's disease, and diabetes.

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: A. "Play quiet music that your grandmother may like." B. "Start rubbing her shoulders and her back." C. "What precipitates the outbursts?" D. "You need to remain calm during the outbursts."

Answer: C Rationale: A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.

An age-related change associated with the cardiovascular system is: A. thinner heart valves. B. decreased blood pressure. C. decreased cardiac output. D. increased compliance of heart muscle.

Answer: C Rationale: Age-related changes associated with the cardiovascular system include decreased cardiac output, increased blood pressure, decreased compliance of the heart muscle, and thickening of the heart valves.

Which is a true statement regarding pharmacologic aspects of aging? A. Elderly have a decreased percentage of body fat. B. Medication compliance is a single-faceted issue among the elderly. C. Absorption may be affected by changes in gastric pH. D. Potential for drug-drug reactions decreases with the number of drugs prescribed.

Answer: C Rationale: During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen because of several factors, such as cost, vision changes, mobility issues, and education.

Which action is included in a nurse's role when providing home care for a client with Alzheimer disease? A. Provide assistance with administering IV fluids. B. Support patient with household errands. C. Provide emotional and physical support. D. Provide assistance with administering oxygen.

Answer: C Rationale: Home health care nurses provide emotional support and intervene if family caregivers become overburdened. The nurse also instructs the family about physical care, the disease process, and treatment. Administering IV and oxygen or supporting patients with household errands is not a relevant role for a home nurse.

Why are IV solutions usually given at a slower rate to older adults? A. Older adults often find infusions painful. B. Older adult may have poor skin turgor. C. Older adults may have cardiac or renal disorders. D. Veins of older adults tend to be rigid.

Answer: C Rationale: IV solutions usually are given at a slower rate to older adults because these clients usually have cardiac or renal disorders. Veins of older adults tend to be rigid and they have poor skin turgor, making venipuncture difficult; however, this factor does not affect infusion. Older adults do not find infusion more painful than other clients.

An older adult seeks medical attention for a new onset of rectal bleeding. For which reason will the nurse perform a complete physical assessment with the client? A. Older adult clients may be poor historians of symptoms. B. The bleeding may be coming from another body orifice. C. More than one body system may be affected. D. The symptom of rectal bleeding is vague.

Answer: C Rationale: In an older person, illness has far-reaching repercussions. The decline in organ function that occurs in every system of the aging body eventually depletes the body's ability to respond at full capacity. Illness places new demands on body systems that have little or no reserve to meet the crisis. Homeostasis is jeopardized. Older adults may be unable to respond effectively to an acute illness or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period. The altered responses of older adults reinforce the need for nurses to monitor all body system functions closely, being alert to signs of impending systemic complication. There is no evidence that the client's report of rectal bleeding is vague or that it is coming from another body orifice. Age of the client does not determine the reliability of the client being able to provide an accurate, detailed history and would not be a reason for a complete phsyical assessment to be performed.

An older adult who is scheduled for the annual influenza vaccination has yet to receive the pneumococcal vaccination. Which action will the nurse take when the client is prescribed to receive both vaccinations? A. Give the pneumococcal vaccine first and schedule the client to return the next day for the influenza vaccine. B. Mix the vaccines in a syringe before administering as one injection in order to minimize client discomfort. C. Give the client the influenza vaccine first and then administer the pneumococcal vaccine in another site. D. Give the influenza vaccine and schedule the client to return in a week for the pneumococcal vaccine.

Answer: C Rationale: Influenza and pneumococcal vaccinations lower the risks of hospitalization and death in older adults. The influenza vaccine, which is prepared yearly to adjust for the specific immunologic characteristics of the influenza viruses at that time, should be given annually in autumn. The pneumococcal vaccine should be administered as recommended. Both of these injections can be received at the same time in separate injection sites. The vaccines are not mixed to be given as one injection. There is no reason for the client to return later to receive either the pneumococcal or influenza vaccinations.

An older adult with mild dementia is diagnosed with a terminal illness. Which action will the nurse take to support this client's right to self-determination? A. Petition the court to appoint a guardian to make decisions for the client. B. Tell the client what treatment is needed. C. Ask the client if there is someone who can help make decisions for treatment. D. Provide care based upon the specific condition.

Answer: C Rationale: People with mild dementia tend to be viewed as incapable of self-determination. However, people with mild dementia may have sufficient cognitive capability to make some, but perhaps not all, decisions. A client may be able to identify a proxy decision maker and yet be unable to select specific treatment options. People with mild dementia may be competent to understand the nature and significance of different options for care and should not be told what treatment is needed as this does not support the client's self-determination. Providing care based upon the specific condition does not support the client's right to self-determination. There is no reason to petition the court to appoint a guardian at this time.

A client at an extended-care facility who has Alzheimer's disease is awake throughout the night. The nurse intervenes with activities that will promote sleep at night, which include: A. Having the client sit at the nurse's station during night-time hours. B. Providing a glass of warm milk for breakfast. C. Walking the client in the facility yard during the day. D. Allowing the client to take a 2-hour nap in the afternoon.

Answer: C Rationale: Regular exercise during the day will enhance sleep at night for clients with Alzheimer's disease. Another activity that helps for interrupted sleep, inability to fall asleep, or both is drinking warm milk at night. The nurse should discourage excessive sleep during the day. Sitting at the nurse's station may be too stimulating at night-time hours.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: A. help the client fill out his menu. B. fill out the menu for the client. C. stay with the client and encourage him to eat. D. give the client privacy during meals.

Answer: C Rationale: Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.

The nurse notes that an older adult is experiencing adverse effects and mild depression from multiple medications. Which question will the nurse ask the client to help determine the reason for these assessment findings? A. "How many times have you forgotten to take your medications?" B. "How many meals do you eat each day?" C. "How would you describe your alcohol consumption?" D. "Have you been taking more than the prescribed doses?"

Answer: C Rationale: Substance use disorders caused by misuse of alcohol and drugs may be related to depression. Even though moderate alcohol consumption has shown to have positive health benefits, such as lowering the risks for cardiovascular disease, alcohol use disorder is especially dangerous in older adults because of age-related changes in renal and liver function as well as the high risk of interactions with prescription medications and the resultant adverse effects. Alcohol and drug misuse in older adults often remains hidden because many older adults deny their habit when questioned. Asking an open-ended question in which the older adult describes their alcohol consumption may be helpful. Food intake will not likely cause adverse effects and mild depression. It is unlikely that the client is taking more than the prescribed doses of the medications. Although it could cause depression, forgetting to take medications would not cause adverse effects, as these are related to the medication.

A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by: A. Serving hot foods at a warm temperature. B. Converting liquid foods to a gelatin texture. C. Placing one food at a time in front of the client during meals. D. Cutting the client's food into small pieces.

Answer: C Rationale: Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.

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? A. Assess for infection. B. Notify the physician. C. Reorient the patient. D. Take the vital signs.

Answer: C Rationale: The client is likely experiencing delirium after surgery. The first action that should be taken by the nurse is to reorient the patient. Hospitalized older adults are at risk for disorientation and confusion. Although the nurse will still need to take the vital signs and assess for infection, reorienting the client remains the first action. If the client can be reoriented, then the nurse may be able to complete the other actions without difficulty or potentially harming the client. The nurse may need to notify the physician if the client is unable to be oriented or if the assessment is abnormal.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? A. Decreased norepinephrine level. B. Increased norepinephrine level. C. Increased acetylcholine level. D. Decreased acetylcholine level.

Answer: D Rationale: A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

Which is an age-related change in the respiratory system? A. Increase in muscle strength and size. B. Difficulty swallowing. C. Increased blood pressure. D. Decreased gas exchange.

Answer: D Rationale: Age-related changes associated with the respiratory system include decreased gas exchange and diffusing capacity; decreased muscle strength, endurance, and vital capacity; and decreased cough efficiency. Age-related changes associated with the cardiovascular system include increased blood pressure. Changes that occur in the musculoskeletal system include loss of muscle strength and size. Difficulty swallowing occurs as an age-related change associated with the gastrointestinal system.

A nursing instructor is preparing a class about age-related changes in the cardiovascular system that occur in the older adult. Which of the following would the instructor most likely include? A. Thinning of the heart valves. B. Decreased arterial resistance. C. Decreased arterial resistance. D. Increased blood pressure.

Answer: D Rationale: Age-related changes in the cardiovascular system include thickening of the heart valves, increased blood pressure, hypertrophy of the heart muscle, and increased arterial resistance.

An older adult seeks medical attention for a new onset of epigastric distress and bilateral arm pain. Which action will the nurse complete? A. Recommend taking an over-the-counter antacid. B. Encourage the client to ambulate. C. Review the contents of the client's most recent meal. D. Assess cardiovascular function.

Answer: D Rationale: Careful assessment of older adults is necessary because they often present with different symptoms than those seen in younger clients. Rather than the typical substernal chest pain associated with myocardial ischemia, older adults may report burning or sharp pain or discomfort in an area of the upper body. When a client reports symptoms related to digestion and breathing and upper extremity pain, cardiac disease must be considered. Because the absence of chest pain in an older client is not a reliable indicator of the absence of heart disease, the client should not be encouraged to ambulate or recommended to take an over-the-counter antacid. Time should not be wasted reviewing the contents of the client's most recent meal.

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: A. Administer an oral dose of prescribed alprazolam (Xanax). B. Raise the upper and lower side rails of the bed. C. Place the client in a Posey chest restraint with ties attached to the bed frame. D. Post a sign stating "You are in the hospital" at the client's eye level.

Answer: D Rationale: Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are not restraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.

Nursing students are reviewing different types of mental health problems in the older adult population. The students demonstrate an understanding of this information when they identify which condition as the most common affective disorder? A. Phobias B. Anxiety C. Schizophrenia D. Depression

Answer: D Rationale: Depression is the most common affective or mood disorder of old age. Although anxiety may be common, anxiety disorders including phobias are not as common as depression. Schizophrenia is a thought disorder and is less common than depression.

An older adult voids a small amount of urine in the toilet but experiences a large volume of incontinence while walking back to the bed. Which nursing intervention would be appropriate for this client? A. Show disapproval to help prevent reoccurence. B. Remind the client to verbalize toileting needs. C. Provide education about medications to treat this problem. D. Implement a prompted, timed voiding schedule.

Answer: D Rationale: Detrusor hyperactivity with impaired contractility is a type of urge incontinence that is seen predominantly in the older adult population. In this variation of urge incontinence, clients have no warning that they are about to urinate. They often void only a small volume of urine or none at all and then experience a large volume of incontinence after leaving the bathroom. Nurses should be familiar with this form of incontinence and plan for routine toileting times with these clients, including the implementation of a prompted, timed voiding schedule. Intermittent catheterization may also be necessary because of postvoid residual urine volumes. Showing disapproval or reminding the client to verbalize toileting needs would be inappropriate actions for this type of incontinence, as the client has no warning they are about to urinate. Medications do exist to treat some forms of incontinence; however, the adverse effects associated with these medications usually make them inappropriate choices for older adults.

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? A. "My dad told me that he felt a little more tired today." B. "My dad said he felt dizzy when he stood up from his chair." C. "My dad's temperature was 97.6 degrees F this afternoon." D. "All of a sudden my dad seemed to become confused."

Answer: D Rationale: Due to age-related changes in the nervous system, a sudden onset of confusion may be the first symptom of an infection. Feeling dizzy on arising suggests orthostatic hypotension. A temperature of 97.6 degrees F may or may not suggest an infection. Typically older adults do not experience a traditional fever. Complaints of being tired could indicate numerous conditions.

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: A. The client's failure to exercise. B. Degeneration in the efficiency of bone joints. C. Decreased muscle mass and joint cartilage. D. Loss of bone density.

Answer: D Rationale: Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.

An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next? A. Decrease walking frequency to three times each week. B. Increase walking at a faster pace. C. Refrain from any form of exercise. D. Continue to walk at his current level.

Answer: D Rationale: Elderly clients may report fatigue with increased activity as a result of a slower heart rate recovery, which may be a physiological response to aging. An appropriate nursing intervention is to educate the client to exercise regularly but also to pace activities. The nurse does not want to tell the client not to exercise, to walk faster, or to decrease frequency.

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? A. Confusion B. Bronchospasm C. Asthma attacks D. Pneumonia

Answer: D Rationale: Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to pneumonia after a rib fracture. Confusion, asthma attacks, and bronchospasm are not conditions that occur after a rib fracture.

An older adult has lost 10% of body weight because of diet changes and exercise. The nurse would provide anticipatory guidance regarding dosage changes in which of the client's daily medications based on this weight loss? A. Acetaminophen B. Aspirin C. Vitamin B and C supplements. D. Diazepam

Answer: D Rationale: Some medications are affected by the percentage of body fat. Even though the client has lost 10% of total body weight, the proportion of body fat increases with age, resulting in an increased ability to store fat-soluble medications, increased accumulation of the drug in the body, and delayed excretion. Medications affected include diazepam. Aspirin and acetaminophen are not among the fat-soluble medications affected by percentage of body fat. Vitamin B and C supplements are water-soluble vitamins and would not be affected by the percentage of body fat.

A department of nursing within a health care organization is adopting the Functional Consequences Theory when caring for older adults. Which action would the nurse take to facilitate using this theory when caring for a client? A. Establish improvement of cognitive function as the overall goal of care. B. Identify reasons for changes in musculoskeletal function. C. Recognize that immune system changes cannot be altered. D. Plan interventions to address consequences of age-related changes.

Answer: D Rationale: The Functional Consequences Theory encourages nurses to consider the effects of normal age-related changes and the damage caused by disease or environment and behavioral risk factors when planning care. This theory suggests that nurses can alter the outcome for clients through nursing interventions that address the consequences of these changes. The Functional Consequences Theory does not focus specifically on musculoskeletal function, immunity, or cognitive functioning.

The nurse identifies which of the following as an age-related change in the respiratory system? A. Increased diffusion capacity. B. Increased vital capacity. C. Increased cough efficiency. D. Increased residual lung volume.

Answer: D Rationale: The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.

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 instructs the client? Select all answers that apply. A. Allow for additional phosphorus intake in her daily diet. B. Decrease the frequency of any exercise. C. Obtain the prescribed bone density screening. D. Increase intake of foods that are high in calcium. E. Take calcium and vitamin D supplements daily.

Answer: D, E Rationale: Older clients may experience decreased bone density and, thus, back pain as a result of aging. Strategies to assist them are to instruct clients to increase calcium in the diet and take calcium and vitamin D supplements. A bone density test made be done to determine the degree of bone loss. The client needs to limit phosphorus intake because a high-phosphorus blood level decreases calcium blood levels. The client needs to continue with a regular exercise program.