Test 4 Geriatrics

food is much more than ____ for the body. It is a source of ___, a symbol of ____, and it has ____

fuel, comfort, celebration, cultural significance

bereavement

grief/mourning following a loss, process (time varies)

anticipatory grief

grieving that occurs before the loss; normal or challenges

hypothyroidism major characteristics

in the older adults- sub-clinical, inconspicuous, and progress slowly toward thyroid failure fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion elevated TSH levels

metabolic syndrome- major characteristics

increased waist circumference ( men > 40, females> 35) plus any two of: B/P over 129/84, over taking anti-hypertensives plasma triglycerides over 149 or taking triglyceride meds HDL levels less than 40 in men and less than 50 in women fasting glucose greater than 99

grief

individual response/perception of loss (psychological, social, spiritual, physical)

Dysphagia nursing management

small frequent meals, pureed or soft foods, high protein, high caloric foods, thickened liquids

osteoporosis major characteristics

spontaneous fractures, height loss, dorsal kyphosis, chronic back pain

hospice care

starts after treatment stops carative- 6 months of less manage symptoms/comfort palliative care plus support serivces

hyperthyroidism major characteristics

tachycardia, fatigue, tremors, and nervousness, enlarged palpable goiter, A fib

Dietary practices of the hindu religious group

they are prohibited from eating all meats

Type 2 diabetes mellitus- major characteristics

polydipsia, polyphagia, polyuria fatigue, blurred vision, weight change, and infections

mourning

process to live with loss; ritualistic practices based on social and cultural norms

hypothyroidism interventions

TSH screenings every 5 years levothyroxine sodium

sodium intake for the older adult

below 1500 mg

metabolic syndrome interventions

reduction of risk factors for diabetes, therapeutic lifestyle changes, nutritional management, drug therapy

Hiatal Hernia major cause of

reflux and esophagitis

loss

response depends on meaning and perception to the person, place, thing, relationship, or life transitions

Lab tests used to diagnose malnutrition

serum albumin- below 3.5 can indicate malnutrition transferrin- below 200- moderate depletion, below 100- severe depletion prealbumin- 5-15 mild to moderate depletion, below 5 severe Total lymphocyte count- normal is 4000-11000

during rounds on the night shift, you note that a patient stops breathing for 1-2 minutes several times during the shift. This condition is known as:

sleep apnea

age-related changes in sleep

sleep latency, reduced sleep efficiency, more awakenings in the night, increased morning awakenings, and increased daytime sleepiness

purpose of a life review

therapeutic, educational, and informational benefits (?)

disenfranchised grief

grief cannot be openly acknowledged

symptoms of a hiatal hernia

heartburn, gastric regurgitation, dysphagia, and indigestion

Q. During a home health visit, an older adult patient asks a nurse if it would be wise to include a multivitamin and mineral supplement into the older adult's daily routine as fewer fruits and vegetables have been eaten lately. The patient heard on the news that the American Medical Association (AMA) has endorsed a daily multivitamin and mineral supplement for Americans and thinks it would be a good idea to take one daily. What do you tell the patient? A. "Supplements do not replace the vitamins and minerals we don't take in by eating." B. "A daily multivitamin and mineral supplement will provide your body with what it needs and is recommended by the AMA, as long as it doesn't interact with prescribed medications." C. "You may overdose on vitamins and minerals, so it's best to avoid a daily multivitamin." D. "Make sure you take a vitamin supplement that doesn't have calcium in it, as you are postmenopausal."

"A daily multivitamin and mineral supplement will provide your body with what it needs and is recommended by the AMA, as long as it doesn't interact with prescribed medications." The American Medical Association now endorses a daily multivitamin and mineral supplement for all Americans to supplement their dietary intake and assure that 100% of the vitamin and mineral recommended daily intake (RDI) is met. Recent literature has determined a correlation between nutrients and chronic disease. Supplements can fulfill some vitamin and mineral deficits caused from dietary conditions; stating otherwise is incorrect. Telling a patient to withhold from taking a vitamin or mineral in fear of overdose is not an appropriate response. Postmenopausal women are in greater need of a calcium-rich diet or supplement.

Q. The older adult patient is a new insulin-dependent diabetic and has the flu. It is the first time the patient has been ill since diagnosis, and the patient does not know what to do to get better . The patient has been vomiting and nauseous for the past 4 hours. The patient monitors themself fasting at 8 AM with a Glucometer and has a blood sugar of 312 mg/dL. The patient pages the nurse practitioner on call. What does the nurse practitioner instruct the patient to do ? A. "Drink 8 ounces of water every hour you have nausea and vomiting." B. "Drink 8 ounces of regular soda every hour you have nausea and vomiting, and increase monitoring of blood glucose." C. "Drink 8 ounces of diet soda every hour you have nausea and vomiting." D. "Drink sugar-free Gatorade every hour you have nausea and vomiting."

"Drink 8 ounces of regular soda every hour you have nausea and vomiting, and increase monitoring of blood glucose." The practitioner should instruct the patient to drink 8 ounces of regular soda every hour. When an individual with diabetes becomes ill with "stomach flu," the stress of even this common illness may precipitate severe hyperglycemia. The individual may detect significant hyperglycemia during routine blood glucose testing and should contact the health care provider for specific instructions on how to the increase insulin dosage. Individuals with nausea and vomiting are generally instructed to take 8 ounces of fluids (non-diet beverages) hourly and increase monitoring of blood glucose levels. Instructions from the provider usually indicate the levels of blood glucose that require an immediate call to the provider or a visit to the emergency department. Non caloric liquids such as diet soda, sugar-free Gatorade, and water should only be used as supplement of caloric liquids when a patient's meal plan cannot be tolerated due to vomiting and nausea.

Q. The nurse is reinforcing teaching with the patient/family of an older adult with obstructive sleep apnea who is being discharged today. Which of the following statements by the patient's spouse would indicate a correct understanding of sleep hygiene? A. "My spouse can go to sleep at different times every night, depending on when they are tired." B. "My spouse can have a few beers after dinner every day since it helps relax and tire them." C. "My spouse can take Tylenol PM tablets a half an hour before going to sleep while relaxing in bed." D. "My spouse can sleep on their side or stomach."

"My spouse can sleep on their side or stomach." The goal of sleep hygiene is to achieve normal sleep. Sleep hygiene measures reinforce habits, routines, and attitudes that promote sleep, and they discourage changes in habits and routines that do not contribute to a good night's sleep. Sleep hygiene measures emphasize stable schedules and bedtime routines, a sleep-friendly environment, avoidance of any substances that would interfere with sleep, regular exercise, and stress reduction. One of the basic measures used to reduce episodes of sleep apnea is sleeping on one's side or stomach. Other basic measures used to reduce episodes of sleep apnea include avoiding central nervous system depressants such as sedative-hypnotics and alcohol

Q. An older adult states, "I'm okay with dying, but I don't want to have any pain when I die." When a hospice/palliative care patient makes such a statement, what is the nurse's priority response? A. "We can work together with your primary care provider to establish a plan to manage your pain." B. "We can work together to evaluate whether your pain medication is working to control your pain as well as you'd like it to." C. "Tell me more about your pain." D. "The doctor will give orders for how to address your pain, and it will be taken care of."

"Tell me more about your pain." The first step in working with a patient who has pain is to find out about the pain. A pain assessment is priority. Then the nurse will work with the primary care provider once the interview and pain assessment along with patient goals of pain control have established. Orders for the pain management program are then shared with the patient/family and an agreement obtained. Once the pain medications have been delivered they will be evaluated to see if goals were being met. The doctor giving orders to address your painis wrong as it doesn't consider the patient and is not a patient centered approach to care delivery.

Q. A gerontologic nurse is discussing nutrition and dietary needs with a new group of residents in an assisted living facility. Which statement by the nurse represents accurate information to communicate to this group of 70-year-olds? A. "You want to increase the amount of fat you eat every day when you enter your 70s." B. "You want to double the amount of fluids you drink to meet the new demands for hydration when you turn 70." C. "You want to decrease the number of calories you consume when you enter your 70s. You no longer need the same number of calories because your basal metabolic rate slows down." D. "You want to consume an 8-gram sodium diet if you have a history of heart disease or cardiovascular disease.

"You want to decrease the number of calories you consume when you enter your 70s. You no longer need the same number of calories because your basal metabolic rate slows down." The basal metabolic rate (BMR) decreases when one gets older, and so older adults need to decrease caloric intake to maintain their current weight. Eating the same amount of food when one has a lower BMR will result in weight gain. Increasing the amount of fat one eats is not recommended, as increases the risk for cardiovascular disease and will add pounds to the frame because fat has a higher calorie content than carbohydrates or proteins. Doubling the fluid intake is not recommended for older adults unless there is a clear reason to do so. The amount of fluid necessary to maintain normal hydration remains fairly constant into the older adult years. Eating an 8-gram sodium diet is contraindicated for members of this age group, or any age group.

4 tasks of mourning

1. accepting the reality of loss 2. experiencing or working through the pain of grief 3. adjusting to an environment in which the deceased is missing 4. emotionally relocating the deceased and moving on with life

a nutritional assessment includes what 6 areas

1. demographic and psycho-social data 2. medical history 3. dietary history 4. anthropometrics 5. medications and laboratory values 6. physical assessment

sleep hygiene measures

1. going to sleep and waking up at the same time everyday 2. only spend time in bed while sleeping 3.eliminate noise and create a dark enviroment 4. limit day time napping 5. a warm beverage and a light nutritious snack before bed 5. avoid caffeine, sleeping pills, and alcohol

three characteristics of meaningful activities for older adults with dementia

1. have a purpose 2. are voluntary 3. foster a sense of well-being

When assessing a pts report of experiencing "problems sleeping" the nurse gathers data related to which of the following? (select all that apply) 1. the patient has difficulty falling asleep 2. the patient wakes up frequently during the night 3. the patient finds it difficult to stay asleep 4. the patient experiences vivid dreams during the night 5. the patient has taken sleep medication in the past.

1. the patient has difficulty falling asleep 2. the patient wakes up frequently during the night 3. the patient finds it difficult to stay asleep

osteoporosis medical management

1200 mg of calcium and 400 of vitamin D weight-bearing and muscle-strengthening exercises

during a nutritional assessment a 79 year old patient responds, "My weight is fine. I weight the same as I did 15 years ago" the nurse responds based on the understanding that older patients: 1. sometimes experience altered metabolic problems to hide weight changes 2. generally guess their weight rather than weigh themselves 3. often exchange lean muscle mass for fat so weight stays the same

3. often exchange lean muscle mass for fat so weight stays the same

how many servings of fruits and vegetables daily?

5

You are employed on an oncology unit and are familiar with palliative care goals. A patient is admitted with a diagnosis of colon cancer with liver metastasis. The patient tells you the pain is a 9 on a scale of 0 to 10. What type of analgesic program would you expect to have available for the patient to best relieve the pain? A. A stepped-care pain management plan with medication choices for mild, moderate, and severe pain complaints B. A pain medication that is delivered routinely at timed intervals around the clock to provide baseline pain management C. Pain medications for use as needed to supplement breakthrough pain D. Colace, MiraLax, and a Dulcolax suppository ordered to treat constipation

A stepped-care pain management plan with medication choices for mild, moderate, and severe pain complaints Pain is prevalent among individuals who are dying and can have a powerful, negative effect on a patient's quality of life. The pain experience is complex, and its management often difficult. A stepped-care approach is recommended, with the use of aspirin or acetaminophen for mild pain, a moderate opiate such as codeine or oxycodone for more constant pain, and a strong opiate such as morphine for severe pain. Pain medication should be given around the clock to promote stable blood pressure levels. Nursing responsibilities include careful pain assessment, education of patients and family caregivers regarding pain medication, and close communication with the prescriber for changes in medication as needed. A pain medication that is delivered routinely at timed intervals around the clock and pain medications for use as needed to supplement breakthrough pain are included in the stepped-care pain management approach. Colace, MiraLax, and a Dulcolax are not a pain management options.

Q. A nurse is teaching an older adult patient complaining of constipation some general care interventions that can be implemented to provide the best possible bowel movement and regularity. Which of the following factors would the nurse include in these instructions? (Select all that apply.) A. "Eat a diet high in fiber by choose five servings of fresh fruit and vegetables daily." B. "Drink plenty of fluids, aiming for 2 quarts minimum daily and water liberally." C. "Get regular exercise, ideally at least 30 minutes three times a week or more." D. "Develop a regular toileting program and respond to the urge to defecate." E. "Take a laxative every day so your bowels move regularly." F. "Use a suppository a few times a week to ensure complete emptying of the bowel contents."

A. "Eat a diet high in fiber by choose five servings of fresh fruit and vegetables daily." B. "Drink plenty of fluids, aiming for 2 quarts minimum daily and water liberally." C. "Get regular exercise, ideally at least 30 minutes three times a week or more." D. "Develop a regular toileting program and respond to the urge to defecate."

Q. The nurse is consulting with the discharge planner at the local hospital regarding a recently admitted patient who has newly diagnosed pancreatic cancer. In planning for the patient's care on discharge, the nurse wonders if the patient may benefit from hospice. What requirements must the patient meet to be eligible for hospice evaluation (Select all that apply.) A. A doctor's referral for the hospice evaluation to occur B. A poor prognosis C. An aggressive approach to the management to the new cancer diagnosis D. A signed do not resuscitate (DNR) order with a palliative care focus E. A life expectancy of 6 months or less F. A Medicare payer source

A. A doctor's referral for the hospice evaluation to occur B. A poor prognosis E. A life expectancy of 6 months or less

Q. An older adult patient is coming to your unit from the emergency room (ER) with a diagnosis of acute abdominal pain. What nursing procedures are associated with an acute abdomen? (Select all that apply.) A. Administering intravenous (IV) fluids as ordered B. Inserting an nasogastric tube to decompress the stomach C. Monitoring and recording vital signs and reporting abnormal results D. Monitoring intake and output accurately every hour E. Assessing abdominal pain, including the presence of nausea, vomiting, diarrhea, and constipation F. Completing a medical and surgical history

A. Administering intravenous (IV) fluids as ordered B. Inserting an nasogastric tube to decompress the stomach C. Monitoring and recording vital signs and reporting abnormal results D. Monitoring intake and output accurately every hour E. Assessing abdominal pain, including the presence of nausea, vomiting, diarrhea, and constipation F. Completing a medical and surgical history

An older adult patient newly diagnosed with type 2 diabetic asks the nurse if exercise would benefit the treatment of the disease... What patient education should the nurse provide? (Select all that apply.) A. Instruction on wearing a medical alert bracelet B. Instruction on checking the blood sugar prior to exercising C. Suggestion that afternoon exercise is best, as this is when insulin resistance is greatest D. Instruction on signs and symptoms of hypoglycemia E. Suggestion to carry a source of carbohydrate for use if needed F. Suggestion to stay low on fluids to avoid overhydration during exercise

A. Instruction on wearing a medical alert bracelet B. Instruction on checking the blood sugar prior to exercising D. Instruction on signs and symptoms of hypoglycemia E. Suggestion to carry a source of carbohydrate for use if needed

Q. Which actions will the nurse take to assess for possible obstructive sleep disorder in a 72-year-old patient? (Select all that apply.) A. Observe for sleep cessation when the patient is sleeping at night. B. Review the patient's history for reports of insomnia and excessive daytime sleepiness. C. Assess the height, weight, and body mass index. D. Review the patient's cardiovascular disease history. E. Ask about previous use or orders for continuous positive airway pressure (CPAP) devices. F. Determine if the patient is using a urinal at bedtime.

A.Observe for sleep cessation when the patient is sleeping at night., B.Review the patient's history for reports of insomnia and excessive daytime sleepiness., C.Assess the height, weight, and body mass index., D.Review the patient's cardiovascular disease history., E. Ask about previous use or orders for continuous positive airway pressure (CPAP) devices. The incidence of sleep apnea increases with age. Direct observation of the patient sleeping can supplement the sleep history. Sleep apnea is associated with excessive daytime sleepiness and reports of insomnia. Obesity is a risk factor for obstructive sleep apnea, and use of a CPAP device to help maintain an open airway during sleep is the treatment for this disorder. A cardiovascular history of hypertension, smoking, and cardiac risk factors increase the likelihood of developing obstructive sleep apnea. Use of a urinal at bedtime is not necessarily associated with sleep apnea.

Q. The nurse at an assisted living facility is developing an event calendar for the patients and is inviting them to take part in a daily walk at a wetlands site in the community. What factors would the nurse want to include in the directions for participation to help the patients enjoy their walk? (Select all that apply.) A. Wear loose-fitting, light-colored clothes in the summer, and bring a hat to protect your head. B. Drink water prior to walking, and replenish water intake after the walk. C. Wear athletic shoes to keep the feet comfortable and protected during the walk. D. Walk 3 hours, and stop to drink water every hour. E. The event will take place when the weather forecast is for a temperature of 70°F, blue skies, and no humidity.

A.Wear loose-fitting, light-colored clothes in the summer, and bring a hat to protect your head., B.Drink water prior to walking, and replenish water intake after the walk., C. Wear athletic shoes to keep the feet comfortable and protected during the walk., E. The event will take place when the weather forecast is for a temperature of 70°F, blue skies, and no humidity.

Q. The nurse works on a palliative care/hospice unit in a skilled care facility. Which of the following nursing activities best represents the principles of palliative care? A. Administering intravenous chemotherapy at the bedside of a resident with leukemia B. Administering intravenous hydration at the bedside of a resident with esophageal cancer C. Administering a morphine intravenous push at the bedside of a resident with colon cancer/liver metastasis D. Administering whole blood and plasma at the bedside of a resident with colon cancer

Administering a morphine intravenous push at the bedside of a resident with colon cancer/liver metastasis Administering a morphine intravenous push at the bedside of a resident with colon cancer/liver metastasis best represents palliative care. Palliative care/hospice forego aggressive treatment in favor of end-of-life care. Palliative care/hospice care measures are often different from strategies used with chronically ill older adults who are not close to death. Administering chemotherapy, blood, and blood products are part of the care of an oncology patient who is actively pursuing aggressive treatment—not necessary part of palliative care.. Oral nutrition and hydration should be maintained as long as a patient is able to swallow safely. Dehydration and anorexia are often of greater concern to family members than to dying patients, who may not be experiencing any resulting discomfort. In many cases, intravenous fluids and feedings are not appropriate. Palliative care physicians and nurses generally believe that medically assisted nutrition and hydration rarely benefit patients at the end stage of life.

Q. An older adult patient has had a cerebrovascular accident (CVA) with dysphagia. What type of care and treatment orders would the nurse expect considering this diagnosis? (Select all that apply.) A. Liquid at 11 AM and 3 PM B. All liquids thickened to a mashed potato consistency C. Pureed diet D. Speech therapy referral E. Aspiration precautions F. Low-fat diet

All liquids thickened to a mashed potato consistency, Pureed diet, Speech therapy referral, Aspiration precautions Dysphagia is a problem that often affects the nutritional status and can occur because of a CVA, oral or neck cancer treatment, or a neuromuscular or neurologic disorder. Dysphagia after a stroke can be successfully treated with swallowing exercises and retraining. Referral to a speech therapist is indicated for patients who display dysphagia. The nurse can help the patient who is dysphagic to ingest thickened liquids and solids; thin liquids are more difficult to swallow. Thickeners can be added to liquids to achieve a consistency that patients can ingest, which is usually the consistency of mashed potatoes. Patients with dysphagia must be assisted during meals, and the nurse or caregiver should carefully ensure that foods are successfully swallowed instead of being trapped in the mouth. Aspiration of liquids or solids can occur and may lead to aspiration pneumonia. Patients with severe dysphagia require enteral tube feeding

Q. Which patient on a medical hospital unit would be at the highest risk for sleep disturbances? A. A 78-year-old patient being treated with intravenous (IV) antibiotics for diverticulitis B. An 80-year-old patient receiving a blood transfusion for a gastrointestinal bleed C. An obese 66-year-old patient admitted with angina, exacerbated chronic obstructive pulmonary disease (COPD), and hypertension D. An 62-year-old patient with a urinary tract infection being treated with IV antibiotics

An obese 66-year-old patient admitted with angina, exacerbated chronic obstructive pulmonary disease (COPD), and hypertension Pain—as experienced with angina, shortness of breath, and coughing that accompany exacerbated COPD and cardiovascular disease or risk factors for cardiovascular disease—put patients at risk for sleep disturbances. A patient with diverticulitis, a gastrointestinal bleed, or a urinary tract infection but no mention of Foley catheter use would not be at risk for sleep disturbances.

Q. An older adult patient complains of weakness, malaise, and weight loss. The patient describes crampy abdominal discomfort during bowel movements in the past 2 days. On rectal exam, the nurse practitioner palpates a mass. The nurse guaiacs a small amount of the patient's stool, and it is positive. She orders a serum carcinoembryonic antigen (CEA). How will the CEA level be used in the course of this patient's care with a diagnosis of colorectal cancer. (Select all that apply.) A. To mass screen everyone the patient lives and works with to rule out the possibility that anyone of them has contracted this cancer B. To determine a baseline to gauge the effectiveness of therapy C. To possibly provide prognostic value D. To monitor for recurrence during the course of care E. To determine the preferred chemotherapeutic agent for treatment F. To determine radiation therapy effectiveness in the treatment plan

B. To determine a baseline to gauge the effectiveness of therapy C. To possibly provide prognostic value D. To monitor for recurrence during the course of care

An older adult patient has lost 30 pounds in the past month. The doctor has ordered a home health evaluation, and you are the nurse who visits. Which of the following statements regarding the patient's history indicates a functional deficit that may be contributing to the patient's weight loss? (Select all that apply.) A. "My daughter calls every week, and I give her a list of the groceries I need. She picks them up when she does her own grocery shopping and brings them by." B. "I have a problem lifting the skillet in the kitchen because its cast iron and very heavy. It causes pain in my arthritic hands and wrists every time I try to use it." C. "The arthritis pain in my knees and hips keeps me from walking some days. When I hurt, even after I take my pain medicine, I don't get up and make my dinner. It's just too hard some days. When you hurt, you aren't hungry." D. "I developed a chest infection and my doctor gave me Biaxin to take for a couple of weeks. When I took this medicine, everything tasted like metal. I stopped eating for a week or two. It was hard to even drink fluids, and I ended up in the hospital." E. "My daughter-in-law comes over three times a week and helps me clean up and does my laundry for me. I don't know what I'd do without her help."

B."I have a problem lifting the skillet in the kitchen because its cast iron and very heavy. It causes pain in my arthritic hands and wrists every time I try to use it.", C. "The arthritis pain in my knees and hips keeps me from walking some days. When I hurt, even after I take my pain medicine, I don't get up and make my dinner. It's just too hard some days. When you hurt, you aren't hungry.", D. "I developed a chest infection and my doctor gave me Biaxin to take for a couple of weeks. When I took this medicine, everything tasted like metal. I stopped eating for a week or two. It was hard to even drink fluids, and I ended up in the hospital." Functional impairment often leads to malnutrition. Older adults with functional impairments may have difficulty performing, or be unable to perform, activities of daily living (ADLs) related to eating. They may be unable to shop for groceries, prepare food, or eat. Conditions that result in shortness of breath, pain, or limited mobility affect an individual's ability or desire to eat. In addition, some medications alter sensory receptors, resulting in greater differences in taste or smell. Flavor, taste, and odor perception generally decline with age and can become exaggerated with some medications. For many older adults, foods that were once cherished and enjoyed as part of their culture now have a different smell and are simply avoided. AARP found that 22% of aging adults who live at home have health-related impairments in ADLs.

Physiological changes- ___ increases while ____ decreases

fat, muscle

common symptoms at the end of life

fatigue nutrition change- not eating or drinking elimination- constipation dyspnea/congestion

Q. An older adult patient has been admitted to the hospice after colon cancer had metastasized to the liver and lungs. The nurse is aware that patients can experience symptoms because of end-of-life changes. Which of the following should the nurse anticipate among dying patients? A. Hyperglycemia B. Diarrhea C. Dyspnea D. Angina

Dyspnea The nurse should anticipate dyspnea. Other common physical problems and symptoms encountered by terminally ill patients include pain, constipation, delirium, altered urinary elimination patterns, altered skin integrity, loss of appetite, dry mouth, nausea and vomiting, restlessness and sleeplessness, difficulty swallowing, and nutritional problems. Family coping and stress, safety needs, and self-care deficits are other important problems. Angina, hyperglycemia, and diarrhea are not common problems or symptoms.

Q. A nurse is teaching an older adult patient that medications can contribute to constipation. Which of the medications on this list should not be included in this teaching? (Select all that apply.) A. Aluminum-containing antacids B. MiraLax C. Antidepressants D. Morphine E. Calcium channel blockers F. Digoxin

F. Digoxin

An older adult patient complains of overwhelming fatigue that begins when getting up from bed every morning. The patient tells you about always being tired and the inability to feel well rested. The patient's family member tells you the patient can snore the roof off the house and stops breathing at night! The family member has been fearful and has awakened the patient on several occasions. The patient frequently complains of a headache in the morning and is crabby and short tempered most of the day. The patient is 5'9" tall and weighs 295 pounds. Which health problem should the nurse suspect? A. Insomnia B. Central sleep apnea C. Obstructive sleep apnea D. Periodic limb movement during sleep

Obstructive sleep apnea In obstructive sleep apnea (OSA), airflow ceases because of complete or partial airway obstruction; respiratory efforts increase in an attempt to open the airway. Hypoxia is the complication that gives this sleep disorder a high risk for complications. Factors associated with OSA include obesity, short neck or thick neck, jaw deformities, large tonsils, large tongue or uvula, narrow airway, and deviated septum. Additionally, smoking, hypertension, and cardiac risk factors increase the likelihood of developing OSA. Older adults with OSA report daytime fatigue, waking with a headache and sore throat or dry mouth, confusion, trouble concentrating, and irritability. The families of older adults with OSA describe snoring, choking, or gasping sounds during the person's sleep. Insomnia, central sleep apnea, and periodic limb movement during sleep are not health problems the nurse should suspect with this patient.

Q. The older adult patient is an 85-year-old with chronic constipation. Which of the following age-related changes may contribute to this complaint? A. Reduced intake of food and fluid B. Reduced peristalsis C. Reduced sodium intake D. Reduced peripheral sensation

Reduced peristalsis Reduced peristalsis may contribute to chronic constipation. Many of the systemic changes in the digestion and absorption of nutrients from the gastrointestinal (GI) tract result from changes in the older adult's cardiovascular and neurologic systems, rather than changes in the GI system. Reduced sodium intake, reduced peripheral sensation, and reduced intake of food and fluid do not yield chronic constipation.

Q. A 65-year-old adult patient presents to the nurse practitioner for an annual physical exam. The patient is 5' 4" and weighs 185 pounds. The patient's diet includes three meals and a snack daily, and the patient's weight has been a problem for the past 20 years on review. The patient follows the 2-gram sodium reduction diet but likes to eat sweets, which elevate the saturated fat and trans fat intake levels higher than recommended. The patient's waist circumference is 40 inches. The patient is being treated for hypertension, obesity, and hyperlipidemia and is taking amlodipine 10 mg daily orally and Lovaza 1 gram three times a day orally. Today's lab work demonstrated normal cholesterol with a more sedentary lifestyle (high-density lipoprotein [HDL] 51 mg/dL), and triglycerides were 139 mg/dL. Today the patient's fasting blood glucose demonstrates 110 mg/dL. What treatment approach is appropriate for this older adult? A. Start a therapeutic lifestyle change program based on the presentation. B. Begin an oral hypoglycemic agent, as the patient is clearly insulin resistant. C. Begin insulin as the clinical presentation supports. D. Continue management in progress, as no additional changes are indicated.

Start a therapeutic lifestyle change program based on the presentation.

Q. A nurse admits an older adult patient to the skilled care unit with symptoms of fatigue, cold intolerance, weight gain, and confusion. Before the primary care provider completes a diagnosis of depression, which of the following lab tests should be completed? A. Random blood glucose B. Estrogen and testosterone C. Serum calcium D. T4 and thyroid-stimulating hormone (TSH)

T4 and thyroid-stimulating hormone (TSH) Older patients with hypothyroidism are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion. The most specific test finding is a subnormal, serum-free T4 level because it corrects for abnormalities in the T4-binding proteins. A random blood glucose test, estrogen and testosterone test, and serum calcium test would be taken on a patient presenting with fatigue, cold, intolerance, weight gain or confusion.

Q. A 69-year-old patient comes to your hospital unit with a diagnosis of acute irritable bowel syndrome. The physician asks you for the patient's albumin and transferrin levels, which were assessed in the emergency room. The patient's albumin level was 3 g/dL and transferrin level was 132 mg/dl. What do the lab results tell you about your patient? A. The patient's liver is synthesizing protein well and has no protein depletion. B. The patient's liver is synthesizing protein well and has mild protein depletion. C. The patient's liver is not synthesizing plasma protein well and has moderate protein depletion. D. The patient's liver is not to synthesizing plasma protein well and has severe protein depletion.

The patient's liver is not synthesizing plasma protein well and has moderate protein depletion. Serum albumin is the serum protein most frequently cited in reference to malnutrition; it reflects the liver's ability to synthesize plasma protein. Albumin has a half-life of about 21 days, so it does not always reflect a patient's current nutritional status. Albumin levels can also be affected by immune status and hydration. Given these limitations, albumin levels below 3.5 g/dL may indicate some degree of malnutrition. Transferrin is a carrier protein for iron and has a shorter half-life of 8 to 10 days. It is a more rapid predictor of protein depletion. Levels below 200 mg/dL may indicate mild to moderate depletion. Levels below 100 mg/dL may indicate severe depletion.

An older adult a patient has experienced severe nausea and vomiting for 2 days since undergoing abdominal surgery. A prealbumin test is ordered. How would you explain the rational for the test to the patient.

The test is used to see how well the body is meeting its demand for protein. this is for the current need

Q. Which of the following is classically a disease of relative insulin insufficiency? A. Normal blood sugar and endocrine system findings on review B. Prediabetes metabolic syndrome C. Type 2 diabetes D. Type 1 diabetes

Type 2 diabetes Type 2 diabetes is classically a disease of relative insulin insufficiency. As with metabolic syndrome, the most important variables associated with type 2 diabetes mellitus are obesity and insulin resistance. Type 2 diabetes starts with a compensatory hyperinsulinemia that affects insulin receptors on target tissues, which leads to insulin resistance that produces hyperglycemia. Type 1 diabetes is not classically a disease of relative insult insufficiency. The pathophysiology of type 2 diabetes mellitus in contrast to type 1 diabetes mellitus involves defects in the cell membrane, receptors, or intracellular pathways. Genetic defects of beta cell function and insulin action interact with lifestyle factors to make diabetes one of the most common chronic conditions: It affects 40% of the older adult population. Normal blood sugar and endocrine system findings and prediabetes metabolic syndrome are incorrect.

an 82-year-old pt with a history of chronic heart and respiratory problems asks the nurse, "what can I do to keep my hemorrhoids from acting up?" which of the following responses made by the nurse are appropriate? select all that apply a. ask if he experiences constipation with any regularity b. encourage him to increase his fluid intake to 2000 mL daily c. suggest he eat more whole grains and fresh fruit d. discuss how he should include a walk into his daily routine e. ask if he has a history of rectal bleeding

a. ask if he experiences constipation with any regularity c. suggest he eat more whole grains and fresh fruit d. discuss how he should include a walk into his daily routine e. ask if he has a history of rectal bleeding

A patient is in the early stages of Alzheimer disease is being admitted to an assisted living facility. The admitting nurse best addresses the patient's needs for appropriate physical activity when: a. asking the patient about activities done for recreation b. showing the pt the exercise equipment available c. having the activity coordinator visit with the patient d. teaching the patient the connection b/n activity and memory

a. asking the patient about activities done for recreation

Myplate emphasizes that half of an individual's food plate should be compromised of ___

fruits and vegetables

the nurse is teaching a newly diagnosed diabetic patient about metformin. What information does the nurse include? select all that apply a. alcohol intake should be limited and taken with food b. overweight patients sometimes poorly tolerate metformin c. oral hypoglycemic agents can increase the risk of hyperglycemia d. metformin has been the cause of anorexia in older patients e. oral hypoglycemic agents affect vitamin D absorption.

a. alcohol intake should be limited and taken with food d. metformin has been the cause of anorexia in older patients

the nurse is assessing an older adult patient with elevated plasma triglyceride levels. What other assessment findings leads the nurse to suspect metabolic syndrome? Select all that apply a. b/p of 148/90 mm Hg b. a fasting blood glucose of 109 mg/dL c. reports frequent urination d. weight measurement of 50 inches e. HDL level of 52 mg/dL

a. b/p of 148/90 mm Hg b. a fasting blood glucose of 109 mg/dL d. weight measurement of 50 inches

When teaching an older adult pt about diet therapy, the nurse plans to assess for barriers to adherence including which factors? SATA a. lifelong habits b. cultural influences c. finances d. dependency e. inability to learn

a. lifelong habits b. cultural influences c. finances d. dependency

The pt w/ hiatal hernia chronically experiences heartburn following meals. the nurse plans to teach the pt to avoid which action because it is contraindicated with a hiatal hernia? a. lying recumbent following meals b. taking in small, frequent, bland meals c. raising the head of the bed on 6-inch blocks d. taking H-receptor antagonist medication

a. lying recumbent following meals

Because of the knowledge of age-related changes in the GI system, the nurse encourages regular screenings for which of the following? select all that apply a. osteoporosis b. vitamin B deficiency c. pernicious anemia d. enlarged liver e. iron deficiency anemia

a. osteoporosis b. vitamin B deficiency c. pernicious anemia e. iron deficiency anemia

an older adult pt is being evaluated for a possible duodenal ulcer. Which of the following assessments support the diagnoses? select all that apply a. passing a moderate amount of dark reddish-brown stool b. reporting a stabbing pain in the epigastric region c. asking for "some crackers to stop my stomach cramps" d. reporting the need to take antacid tablets most days e. having a rigid abdomen about 2 hrs before eating

a. passing a moderate amount of dark reddish-brown stool c. asking for "some crackers to stop my stomach cramps" d. reporting the need to take antacid tablets most days

The nurse assessing patients for diabetes looks for the classic signs, including which of the following? select all that apply a. polyuria b. polycythemia c. polydipsia d. polyphagia e. ployandrony

a. polyuria c.polydipsia d. polyphagia

What assessment findings support the diagnosis of hyperthyroidism in the older adult? select all that apply a. tremors. b. heat intolerance c. tachycardia d. palpable goiter e. A fib

a. tremors. c. tachycardia d. palpable goiter e. A fib

physical responses to grief

altered: functional ability, strength/fatigue, sleep and rest, nausea, appetite, constipation, pain

older adults should increase their intake of

fruits and vegetables, whole grains, diary

The nurse who works with older adults explains the age related changes in sleep to the student. Which statements are consistent with this knowledge? a. the amount of time spent in REM increases b. REM sleep is interrupted more by awakening at night c. people spend more time in the lightest stage of sleep d. stages 3 and 4 of non-REM sleep are not as deep. e. changes in circadian rhythm can affect sleep

b. REM sleep is interrupted more by awakening at night c. people spend more time in the lightest stage of sleep d. stages 3 and 4 of non-REM sleep are not as deep. e. changes in circadian rhythm can affect sleep

A pt has pernicious anemia. what action by the pt and family indicates teaching for this condition has been effective? a. proper administration of oral vitamin B12 b. correct technique for IM injections c. choosing aspirin over ibuprofen d. preparing a low carb meal

b. correct technique for IM injections

Type 2 diabetes mellitus interventions

educate on disease, change to diabetic diet, emergency identification, blood glucose monitoring, exercise, lifestyle changes, skin alteration and wound care- mild soap and cut toe nails straight across

Palliative care

begins at diagnosis treatment may continue manage symptoms/comfort relief of suffering by means of early identification and assessment and treatment of pain and other problems

Type 2 diabetes mellitus drugs

drug combinations including: thiazolidinediones to preserve beta cell function while controlling glucose levels, biguanides like metformin

complicated grief

dysfunctional grieving for extended period of time or severity

constipation- caused by

compication of polypharmacy, diet, mechanical obstruction, mobility and functional issues

hyperthyroidism treatment

controversial in the older adult radioactive sodium iodine, surgical treatment, beta-blockers used to treat

The nurse is teaching a 79-year-old with type 2 diabetes about the importance of regular exercise suggests that the patient: a. swim 10 laps in the community pool three times a week. b. enroll in a daily lunch time aerobics class c. lift 5 pound weights in a routine of 10 reps in each arm d. walk on the treadmill each morning for 30 minutes

d. walk on the treadmill each morning for 30 minutes

constipation- treated by

dietary measures- increased fluids and fiber along with light exercise and a regular toileting routine medication