Ch. 14 Older Adults

Therapeutic communication

An approach used to demonstrate concern for the older adult's welfare. Occurs when patient's accept and respect nurses who meet their expectations of sound knowledge and competence

The nurse suspects that an alteration in which body system is the reason for difficulty sleeping and excessive daytime napping by an older adult? A. respiratory system B. neurological system C. GI system D. musculoskeletal system

B. rationale: Older adults frequently report alterations in the quality and quantity of sleep or slumber, including difficulty falling asleep, difficulty staying asleep, waking too early in the morning, and excessive daytime napping. These may be because age-related changes in the neurological system, which may lead to alterations inn the sleep-wake cycle. Age-related alterations in the respiratory system include decreased lung expansion and a decreased ability to cough deeply. Alterations in the GI system may cause discomfort from delayed gastric emptying, constipation, and flatulence in older adults. Alterations in the musculoskeletal system resulting from aging may cause osteoporosis

Which condition may result in difficulty initiating voiding and maintaining a urinary stream in older men? A. stress incontinence B. prostatic hypertrophy C. urinary tract infection D. weakened bladder muscles

B. rationale: difficulty initiating voiding and maintaining a consistent urinary stream may occur because of an enlarged prostate, or prostate hypertrophy. Stress incontinence is usually seen in women, and the urine is releases involuntarily during sneezing, coughing, and laughing because of stress on the urinary bladder. Urinary tract infections may not lead to an inconsistent urine stream, Weakened bladder muscles lead to urinary incontinence.

Which assessment finding in a patient is an indication of an age-related change? A. white sclera B. yellowing of the lens C. decreased sensitivity to glare D. dilation of the pupils in the presence of light

B. rationale: with aging, the crystalline fibers present in the lens stop regenerating and undergo many posttranslational changes. These changes make the lens appear opaque and yellowish.

Electroconvulsive therapy

Sometimes used for treatment of resistant depression when medications and psychotherapy do not help

Which statement by an older adult indicates effective learning regarding the benefits of exercise? SATA A. "it build endurance" B. "it increases muscle tone" C. "it reduces stress" D. "it improves brain health" E. "it contributes to weight gain"

a, b, c, d rationale: Regular daily exercise such as walking, builds endurance, increases muscle tone, improves joint flexibility, strengthens bones, reduce stress, and contributes to weight loss (not weight gain)

The nurse identifies that an older patient with impaired vision and nocturne is at an increased risk for which event? A. falls B. stroke C. heart disease D. chronic lung disease

A. rationale: Impaired vision prevents an older adult from seeing tripping hazards such as rash cans. The increase in urine output associated with nocturia increases the risk for falling by increasing the number of attempts to get out of bed to void. Diabetes mellitus, hypertension, and hyperlipidemia are the risk factors of stroke. Obesity, stress, and stroke are risk factors for heart disease. Smoking tobacco is a risk factor for chronic lung disease

Delirium

An acute, fluctuating confusional state Onset = fast Duration = hours to less than 1 month Cause = multiple, such as surgery, infection, drugs Reversibility = may be possible Management = remove or treat the cause Nursing interventions = Reorient the patient to reality; provide a safe environment

Validation therapy

An alternative approach to communicate with an older adult who is confused. Validation therapy accepts the description of time and place as stated by the older adult. By listening with sensitivity and validating what the patient is expressing, the nurse conveys respect, reassurance and understanding. Validating or respecting older adults' feelings in the time and place that is real to them is more important than insisting on the literally correct time and place

Benign prostatic hypertrophy

An enlarged prostate gland, which can cause urinary retention, frequency, incontinence, and urinary tract infections, but it is not the result of hormone changes.

The nurse suspects which condition in an older adult with a history of fatigue and recent loss of a close family member? A. delirium B. depression C. Lewy body disease D. Alzheimer disease

B. rationale: Older adults may experience late-life depression, but it is not a normal part of aging. Loss of a significant loved one or admission to a nursing center sometimes causes depression. Fatigue or decreased ability to do usual activities is often a sign of anemia, thyroid problems, depression, or neurological or cardiac problems. Delirium may be manifested by cartable affective changes and exaggeration by personality type. It is also associated with acute physical illness. Lewy body disease and Alzheimer disease are the generalized impairments of intellectual functioning that interfere with social and occupational functioning as aging progresses

Which condition can be inferred in a patient who experiences involuntary release of urine while laughing, sneezing, and coughing? A. diabetes mellitus B. stress incontinence C. prostate hypertrophy D. urinary tract infection

B. rationale: Older woman, particularly those who have had children, experience stress incontinence, an involuntary release of urine that occurs when they cough, laugh, sneeze, or lift an object. This is a result of a weakening of the perineal and bladder muscles. With diabetes mellitus, a patient may show such symptoms as increased frequency of urinating. Prostate hypertrophy can lead to difficulty in initiation of voiding and maintenance of the urinary stream. Patients may have pain while urinating when experiencing a urinary tract infection.

Which physiological change occurs with aging? A. decreased stomach pH B. decreased bladder capacity C. Decreased airway resistance D. Increased peripheral circulation

B. rationale: aging, the process of becoming older, leads to reduced bladder capacity because bladder elasticity diminishes. The stomach pH increases with aging because the body produces less hydrochloric acid with advancing age. Aging decreased upper airway size and results in increased airway resistance. Peripheral circulation decreases with aging because of a narrowing of the arteries.

When reviewing the diagnostic and laboratory reports of four older patients, the nurse identifies that which finding is an age-related change? A. stomach pH of 2.5 B. cardiac output of 3.2 L/min C. bladder capacity of 500 mL D. systolic BP of 120 mm Hg

B. raionale: a normal cardiac output is in the range of 4-8 L/min. With aging, a decreased contractile strength of the myocardium results in decreased CO. CO of 3.2 L/min is most likely related to aging. A stomach pH of 2.5 is within the normal range of 1.5 to 3.5. A bladder capacity of 500 mL is within the normal range of 400 to 600 mL. A systolic BP of 120 mm Hg is within the normal range

Which reason may be the cause of decreased mobility of the ribs in older adults? A. Curvature of the thoracic spine B. Calcification of the costal cartilage C. Decrease in respiratory muscle strength D. Increase in the anteroposterior diameter of the chest

B. rationale: Decreased mobility of the ribs is caused by calcification of the costal cartilage. This occurs with aging. The curvature of the thoracic spine is known as dorsal hypnosis and is caused by vertebral change. A decrease in respiratory muscle strength and an increase in the anteroposterior diameter of the chest are age-related changes cause by configurational changes in the thorax.

Which statement is true regarding delirium? A. the onset of delirium is insidious B. there are short, daily fluctuations in symptoms C. the patient with delirium generally has a normal level of alertness D. progression of the delirium is gradual, usually over months and years

B. rationale: With delirium, there are short, daily fluctuations inn symptoms; they are worse at night, in darkness, and one awakening. The onset of delirium is sudden or abrupt. In the patient with delirium, alertness fluctuates; the patient can be lethargic or hyper vigilant but not normal. Progression of delirium is abrupt, not gradual over months and years.

Which finding is an abnormal physiological change in the older adult? A. decreased awareness of body positioning in space B. decreased systolic blood pressure C. increased airway resistance D. increased stomach pH

B. rationale: aging may cause alterations in the cardiovascular system, and the older adult may have increased systolic blood pressure because of increase peripheral vascular resistance; therefore, a decreased systolic blood is an abnormal physiological change in an older adult

Which modifiable risk factor is the MOST preventable cause of disease and death in the United States? A. alcohol use B. smoking C. poor dietary choices D. lack of physical exercise

B. rationale: cigarette smoking is a risk factor for the four most common causes of death: heart disease cancer, lung disease, and stroke. It is the most preventable cause of disease and death in the United States. Alcohol use, poor dietary choices, and lack of exercise are not the most preventable caused of disease and death in the United States

After reviewing the health records for four older patients, the nurse identifies that which set of findings reflect normal age-related physiological changes? A. decreased prostate size, decreased sensitivity to glare, and increased firm erections B. increased fat tissue. decreased thymus size, and increased anti-inflammatory hormones C. narrowing of blood vessels, thickening of vessel lumen, and increased elasticity of heart valves D. increased thyroid secretions, increased T-cell function, and decreased systolic blood pressure

B. rationale: in older patients, the amount of fat tissue increases, the thymus gland decreases in size and volume, and the anti-inflammatory response increases. With age, the size of the prostate increases sensitivity to glare increases, and erections are less firm. There is increased elasticity of the heart valves in older patients, while thyroid secretions and T-cell function decrease. Systolic blood pressure increases with age.

Which physiological change inn the endocrine system is common in the older adult? A. increased thyroid hormone secretions B. increased pancreatic fibrosis and a decreased sensitivity to insulin C. increased secretion of enzymes and hormones in the pancreas D. decreased anti-inflammatory hormones, such as cortisol and glucocorticoids

B. rationale: increased fibrosis and a decreased sensitivity to insulin in the pancreas is a part of the aging process. Aging decreases thyroid hormone secretions and secretions of enzymes and hormones in the pancreas. Aging increases anti-inflammatory hormones, such as cortisol and glucocorticoids

Which endocrine change is associated with aging? A. increased sensitivity to insulin B. increased thyroid secretions C. decreased ability to respond to stress D. decreased anti-inflammatory hormone secretions

C. rationale: Aging decreases the ability to respond to stress because the functional ability of the body declines with age, and hormone production is altered. Aging decreases sensitivity to insulin. The thyroid gland becomes nodular with age, which results in decreased thyroid secretions. Anti-inflammatory hormones are increased in older adults because of degenerative changes and oxidative stress.

Which physiological change of the endocrine system occurs because of aging? A. increased sensitivity to insulin B. increased thyroid secretions C. increased anti-inflammatory hormones D. increased secretions of pancreatic enzymes

C. rationale: An increase in the production of glucocorticoids occurs during aging, which, in turn, increases the production of anti-inflammatory hormones

In which health care setting would the nurse MOST likely find an older adult with chronic dehydration exacerbated by acute illness? A. home care B. nursing home C. hospital D. ambulatory care

C. rationale: In a hospital care setting, an older adult may experience chronic dehydration exacerbated by acute illness; this could occur because of medications and diagnostic procedures that limit the intake of fluids. In a home care setting, nurses usually provide treatments for ongoing conditions rather than acute illnesses. In a nursing home setting, residents usually so not have acute illnesses. Patients in an ambulatory care setting typically care undergoing an outpatient test, procedure, or surgery

When planning health promotion strategies for older adults, which issue creates a barrier for health care providers? A. health literacy B. patient motivation C. lack of consistent guidelines D. previous health care experiences

C. rationale: The challenges of engaging older adults in health promotion and disease prevention are complex and also affect health care providers. Barriers for health care providers include beliefs and attitudes about which services and programs to provide, their effectiveness and the lack of consistent guidelines, and absence of a coordinated approach. Health literacy, personal motivation, and previous health care experiences are married for the older adults or older patients.

Which physiological change of the endocrine system occurs because of aging? A. increased sensitivity to insulin B. increased thyroid secretions C. increased anti-inflammatory hormones D. increased secretions of pancreatic enzymes

C. rationale: an increase in the production of glucocorticoids occurs during again, which, in turn, increases the production of anti-inflammatory hormones

What is the goal of reminiscence therapy when used with an older adult? A. to produce a positive mood B. to reduce the patient's anxiety C. to resolve current conflicts by recollecting the past D. to evaluate the patient's judgment and general knowledge

C. rationale: as a therapy, reminiscence uses the recollection of the past to bring meaning and understanding to the present and to resolve current conflicts. Looking back to positive resolutions of problems reminds an older adult of coping strategies used successfully in the past. A goal of reminiscence therapy is not necessarily to produce a positive mood or to reduce anxiety. Reminiscence therapy is not necessarily helpful in evaluating the patient's judgment and general knowledge

An older patient with dementia will exhibit which clinical feature? A. generally impaired orientation; inattention B. reduced consciousness; incoherent speech C disorientated to place or time; slowed response D. psychomotor retardation or agitation; diurnal effects

C. rationale: dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. A patient with dementia is usually oriented to person but not to place or time. A patient with dementia has slowed response and may be labile.

Which condition in older men is often the result of hormonal changes? A. presbyopia B. presbycusis C. gynecomastia D. benign prostatic hypertrophy

C. rationale: gynecomastia, enlarged breast in men, is often at the result of medication side effects, hormonal changes, or obesity

Which condition in older men is often the result of hormonal change? A. presbyopia B. presbycusis C. gynecomastia D. benign prostatic hypertrophy

C. rationale: gynecomastia, enlarged breast in men, is often the result of medication side effects, hormonal change, or obesity

Which statement about normal Gi changes in older adults indicates that a student nurse needs further education? A. "peristalsis decreases" B. "the pH of the stomach increases" C. "salivary secretions decrease" D. "the size of the abdomen decreases"

D. rationale: Aging leads to an increase in the amount of fatty tissue in the trunk and abdomen. Because muscle tone and elasticity decease, the abdomen becomes more protuberant. Peristalsis deceases in older adults because of smooth muscle changes, leading to constipation. The pH of the stomach increases in older adults. Salivary secretions decrease in older patients

Which statement about normal GI changes in older adults indicates that a student nurse needs further education? A. "peristalsis is decreases" B. "the pH of the stomach increases." C. "salivary secretion decreases" D. "the size of the abdomen decreases"

D. rationale: Aging leads to an increase in the amount of fatty tissue in the trunk and abdomen. Because muscle tone and elasticity decrease, the abdomen becomes more protuberant. Peristalsis decreases in older adults because of smooth muscle changes leading to constipation. The pH of the stomach increases in older adults. Salivary secretions decrease in older adults

Which statement best explains sexuality in an older adult? A. When the sexual partner passes away, the survivor no longer feels sexual B. Sexual desires and thought begin to diminish in the seventh decade of life C. any outward expression of sexuality suggests that the older adult is having a developmental problem D. older adults, whether healthy or frail, need to express sexual feelings

D. rationale: All older adults, whether healthy or frail, need to express their need for intimacy and sexual feelings. Sexuality and the need to express sexual feelings remain throughout the human life spam. Men and women continue to have sexual desires, thoughts, and actions throughout all decades of life. Even when a sexual partner passes away, the survivor will still feel the need to express sexual feelings, even if it takes time. An outward expression of sexuality is normal and does not indicate a developmental problem

Which respiratory change occurs in older adults? A. increased ciliary activity B. increased number of alveoli C. increases cough reflex D. increased chest wall rigidity

D. rationale: Chest wall righty is increased in older adults; it becomes stiffer and more rigid as age processes as a result of rib and cartilaginous calcification. The number of cilia decreases with aging. There are few alveoli, and the cough reflex decreases in older adults

Which clinical feature is associated with delirium? A. lasts for months to years B. minimal impairment of attention C. onset is slow and often unrecognized D. calls out repeatedly with the same phrase

D. rationale: Clinical features of delirium include calling our repeatedly with the same phrase. The duration is hours to less than 1 month, longer if unrecognized and untreated. With delirium, attention is impaired and fluctuates. The onset is abrupt

Which statement is true regarding dementia? A. the onset is sudden B. the condition worsens during the daytime C. the effects of dementia are self-limited D. the onset is often unrecognized

D. rationale: Dementia starts slowly and is often unrecognized. Dementia does not worsen wither in the daytime or at night. It lasts for months to years

Keratoses

Irregular, round or oval, brown, and watery ;lesions usually found on an older adult's skin because of aging

Which is true about the functional ability of MOST older adults? A. they are active B. they are involved members of their communities C. the remain functionally independent D. they have lost the ability to care for themselves E. they are unable to make decisions concerning their needs

a, b, c rationale: Older adults also have a wide range of functional ability. Most older adults are active and involved in their communities. Most older adults remain functionally independent despite the increasing prevalence of chronic disease. A smaller number have lost the ability to care for themselves, are confused or withdrawn, or are unable to make decisions concerning their needs

Persistent pain in an older adult can lead to which consequence? SATA A. depression B. changes in gait C. sleep difficulties D. impaired cognition E. fear of using analgesics

a, b, c rationale: the consequences of persistent pain include depression, loss of appetite, sleep difficulties, changes in gait and mobility, and decreased socialization. Pain does not impair cognition. Fear of using analgesics may cause the pain to persist for a longer time, but it is not a consequence of persistent pain

Which sensory change is the nurse most likely to find in an older adult? SATA A. presbyopia B. presbycusis C. changes in proprioception (decreased awareness of body positioning in space) D. buildup of cerumen E. increased sensitivity to touch

a, b, c, d rationale: there is often a decrease in touch sensitivity owing to a decreased number of skin receptors

Which vision change is associated with the aging process? SATA A. decreased accommodation from near to far vision B. increased sensitivity to the effects of glare C. difficulty moving from bright to dark environments D. difficulty distinguishing between blue and green color shades E. dark colors, such as blue and black, appear the same

a, b, c, d, e

Which factor increases the risk of falls among older adults? SATA A. poor lighting B. dizziness C. use of sedatives D. improper use of assistive devices E. unfamiliar environment of a hospital room

a, b, c, d, e rationale: Poor lighting makes it difficult to see properly. A new or existing illness (eg., dizziness weak gait) ma cause an older adult to fall. Sedatives and tranquilizers sometimes prescribed for older adults who are acutely confused often cause or exacerbate confusion and increase risks for falls or other injuries. The improper use of assistive devices, such as walkers, may lead to falling. The unfamiliar environment of a hospital room may contain obstacles to safe ambulation

The nurse identifies that a hospitalized older adult with which condition is at increases risk for delirium? SATA a. immobilization b. sleep deprivation c. infection d. dehydration e. pain

a, b, c, d, e rationale: The risk increases when hospitalized older patients experience immobilization, sleep deprivation, infection, dehydration, pain, sensory impairment, drug interactions, anesthesia, and hypoxia

which physiological change is common in olde adults? SATA A. periodontal disease B. loss of skin elasticity C. decreased cough reflex D. decreased muscle mass E. thickening of blood vessel walls F. thickening of the tympanic membrane

a, b, c, d, e, f rationale: common physiological changes associated with normal aging are not pathological in themselves, but they can make older adults more vulnerable to common clinical conditions and diseases . Changes includes periodontal disease, loss of skin elasticity, decreased musale mass, thickening of blood vessel walls, and thickening of the tympanic membrane

After working as an accountant for the same company for 40 Yeats, a 63-year-old adult chooses to retire. The patient's spouse does not work outside of their home, babysits for the grandchildren as needed, and belongs to numerous church committees. Which is a psychosocial stressor for this patient? SATA A. The loss of the patient's work role B. The risk of social isolation C. The need for the spouse to get a job outside of the home D. How the spouse expects to divide household tasks when the patient is retired E. The age of the patient at the time of retirement

a, b, d rationale: the psychosocial stresses of retirement are usually related to role changes with a spouse or within the family, loss of the work role, and social isolation. Whether the spouse will need to get a job outside of the home is not usually a major stressor. The age of the patient at the time of retirement is usually not a major psychosocial concern

Which change in the reproductive system occurs in older women? A. dry vagina B. decreased libido C. large breasts D. degeneration of ovaries E. reduced size of the vagina

a, b, d, e rationale: older women experience a reduced responsiveness of the ovaries to pituitary hormones and a resultant decrease in estrogen and progesterone levels. This may result in the woman having a decreased libido. Hormonal changes can also cause dryness of the vaginal mucosa. Aging is also associated with degeneration of ovaries and atrophy of vagina, uterus, and breasts. Because of reduced estrogen levels with aging, breasts reduce in size

Which change in the reproductive system occurs in older women? SATA A. Dry vagina B. Decreased libido C. Large breasts D. Degeneration of ovaries E. Reduced size of the vagina

a, b, d, e rationale: older women experience a reduced responsiveness of the ovaries to pituitary hormones and a resultant decrease in estrogen and progesterone levels. This may result in the woman having a decreased libido. Hormonal changes also cause dryness of the vaginal mucosa. Angina is also associated with degeneration of ovaries and atrophy of vagina, uterus, and breasts. Because of reduced estrogen levels with again, breasts reduce in size.

The nurse suspects that which condition is the cause of an older patient's fatigue and decreased ability to perform usual activities? SATA A. anemia B. depression C. fecal incontinence D. cramping sensations E. thyroid dysfunction

a, b, e rationale: Fatigue or a decreased ability to do usual activities is often a sign of anemia, thyroid problems, depression, or neurological or cardiac problems. This is related to decline in neural drive or nerve-based motor common to working muscles that result in a decline in the force output. This can result in peripheral muscle fatigue and a decreased ability to do usual activities. Fecal incontinence and cramping sensations are signs of GI problems and do not cause fatigue or muscle weakness.

Which criteria should be considered when selecting a nursing center? SATA A. The center should provide quality care B. The center should offer mealtime choice C. The residents' room should be similar to decrease confusion D. The staff should focus on completing tasks E. The center should facilitate active communication from the staff to the resident and family

a, b, e rationale: Selecting a nursing center is an important process. It should provide quality care so that the older adult feels comfortable. It should offer quality food and mealtime choices so that proper nutrition can be provided to the adult. The nursing center should facilitate active communication from the staff to the patient and family, so that the person can share feelings and problems. Patients should be encouraged to personalize their rooms to feel comfortable. Members of the nursing center staff should focus on the person and not on the tasks

Which change can be observed in the integumentary system as a result of aging? SATA A. spots and lesions on the skin B. wrinkles on the face and neck C. resilient and supple skin D. thickened epithelial layer E. glandular atrophy

a, b, e rationale: aging produces physiological changes in the body. Some changes occur in the integumentary system. Spots and lesions appear on the skin. Wrinkles on the face and neck region reflect lifelong patterns of muscle activity and facial expression, the pull of gravity on tissue, and diminished elasticity. Glandular atrophy (oil, moisture, sweat glands) occurs. Skin loses resilience and moisture. The epithelial layer thins, and elastic collagen fibers shrink and become rigid.

Which intrinsic factor increases the risk of falls among older adults? SATA A. impaired vision B. inappropriate footwear C. conditions affecting mobility D. adverse medication reactions E. conditions affecting balance and gait

a, c, d, e rationale: Intrinsic factors that increase the risk of falling in older adults include impaired vision, conditions affecting mobility, adverse medication reactions and conditions affecting balance and gait. Impaired vision prevents an older adult from seeing tripping hazards, such as trash cans. Lower extremity weakness and general fatigue and reconditioning can make it difficult for a patient to get out of bed. Once the patient does get out of bed, often the patient is unsteady, dizzy, and prone t o falling. Medications causing orthostatic hypotension also increase the risk for falls because the blood pressure drops when an older adult gets out of a bed or chair. Conditions affecting balance, such as dizziness, and a weak gait also may lead to an increased risk of falling. Inappropriate footwear is an extrinsic factor that may increase the risk of falling

When caring for an older adult who is hospitalized, the nurse identifies that which no medical condition increases the patient's risk for delirium? A. unfamiliar surroundings B. dehydration C. separation from support systems D. pain E. stress

a, c, e rationale: In an acute care setting, older patients are at risk of developing acute delirium. Nonmedical causes of delirium include unfamiliar surroundings, unfamiliar staff, bed rest, separation from support systems, and stress. Dehydration and pain are medication conditions that increase the risk for delirium

Which finding is commonly exhibited in an older adult with delirium? SATA A. incoherent speech B. awake level of consciousness C. fluctuation in alertness D. impairment of remote memory E. worsening of symptoms at night

a, c, e rationale: with delirium, the speech is often incoherent. attention is impaired and fluctuates. There are short, daily fluctuations in symptoms that are worse at night, in darkness, and on awakening. Patients with dementia and depression have an awake level of consciousness. With delirium, remote memory generally remains intact

Which condition of the lower GI tract is a common-age related change? SATA A. diarrhea B. vomiting C. flatulence D. gastric ulcer E. constipation

a, c, e rationale: alterations in the lower GI tract lead to diarrhea, flatulence, and constipation. Because of aging, peristalsis movement becomes slow, and alterations ins secretions occur. Alterations in the lower GI tract do not cause vomiting or gastric ulcers. When vomiting accompanies the onset of an acute illness, an older adult is at risk for dehydration; further assessment is needed. Stomach ulcers are usually cause by Heliobacter pylori bacteria or NSAIDs

Which physiological change in the eyes is expected in the aging adult? SATA A. altered color perception B. larger pupils C. decreased sensitivity to glare D. yellowing of the lens E. decreased accommodation from near to far vision

a, d, e rationale: visual acuity decreases with age because of retinal damage, reduced pupil size, development of opacities in the lends, or loss of lens elasticity. Altered color perception, yellowing of the lens, and decreased accusation from near tofu vision are common findings in older adults and are considered to be normal physiological changes. Smaller, not larger, pupils are a normal age-related change. Increased, not decreased, sensitivity to glare is an expected finding in the older adult

Which factor places an older adult who is hospitalized at risk of falls? SATA A. osteoporosis B. increased airway resistance C. impaired healing D. indwelling urinary catheter E. lower extremity weakness F. cognitive impairment

a, d, e, f rationale: older adults who are inactive have low bone and muscle mass or muscle tone and are at higher risk of osteoporosis, which can cause falls. Pieces of equipment, such as wired from monitors, IV tubing, urinary catheters, and other medical devices, become obstacles to safe ambulation. There are conditions and illnesses (eg., dizziness, weak gait) that increase the risk for falls. Persons with cognitive impairment may exhibit behaviors, such as wandering, that may be unsafe and put them at risk for falls and other injuries. Conditions that increase airway resistance may cause respiratory problems but they are not significant risk factors for falls. Impaired hearing is commonly experienced by older adults; it is not a significant risk factor for falls

Which nursing intervention would be beneficial for an older adult patient with chronic obstructive pulmonary disease(COPD)? A. obtaining a history about exposure to artificial nail products B. monitoring BP frequently C. Placing a feather pillow under the head D. monitoring changes in peripheral pulses E. monitoring respirations and breath sounds

a, e rationale: chronic lung disease, specifically COPD, is the third leading cause of death in those aged 64 years and older. Lung injury from inhalants, such as tobacco smoke, secondhand smoke, and fumes from hair dyes, artificial nail products, and paints can lead to COPD. COPD causes airflow blockage and breathing-related difficulty, so the nurse needs to monitor respirations and breath sounds. Frequent monitoring of BP is not needed for a patient with COPD. Keeping a feather pillow under the head of a patient can precipitate allergic respiratory reactions that may exaggerate the condition. Monitoring cages in peripheral pulses would be beneficial for the patient with heart and neurovascular disorders

Delirium

acute confusional state An acute change in attention and awareness that develops over a relatively short time interval and is associated with additional cognitive deficits, such as memory deficit, disorientation, or perceptual disturbances

Which criteria would the nurse recommend for choosing a nursing center? SATA A. The rooms are set up like hospital rooms B. There is adequate staffing to regularly help with recreational activities C. The staff focus on the person, not the task D. Three meals are served daily E. Family involvement is encouraged

b, c, e rationale: A quality nursing home should have staff who regularly help residents with social and recreational activities. Staff should be actively involved with assisting the residents; they should focus on the person, not on the task. Staff should always encourage family involvement, whether families wish to provide information, ask question, participate in care planning, or help with social activities or physical care. The nursing center should not feel like a hospital. Residents should be encouraged to personalize their rooms. Residents should be offered quality food and mealtime choices.

Which strategy can the nurse implement when providing discharge instructions to an older adult with a hearing impairment? SATA A. speak loudly B. face the patient C. present one concept at a time D. speaking high-pitched tones E. include the family caregivers in the teaching session

b, c, e rationale: When providing education to a person with a hearing impairment, the nurse should face the patient. The nurse should present one concept at a time and allow the older adult time to process information. Sharing information with a caregiver provides someone to clarify instructions with the patient after discharge. The nurse should speak with a normal volume and in low-pitched tones.

Which question will the nurse ask to assess the risk for stroke in an older adult? SATA A. "Do you have a history of cancer?" B. "Do you have a history of transient ischemic attacks?" C. "Do you have a history of hypertension?" D. "Do you have a family history of diabetes?" E. "Do you have a family history of heart disease?" F. "Do you smoke?"

b, c, e, f rationale: Risk factors for stroke include hypertension hyperlipidemia, diabetes mellitus, history of transient ischemic attacks, and family history of cardiovascular disease. Cigarette smoking is a risk factor for the four most common causes of death in older adults: heart disease, cancer, lung disease, and stroke. History of cancer is not a risk factor for stroke. A family history of diabetes increases the risk o developing diabetes.

The nurse identifies that an older adult is experiencing cognitive impairments that are not normal aging changes when a family member reports which patient behavior? SATA A. getting confused when following a set of directions B. using poor judgment when making decisions C. inability to remember items on a shopping list E. inability to make conversations with others E. inability to help grandchildren with simple math calculations

b, d, e rationale: Symptoms of cognitive impairment, such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgement, are not normal aging changes and require further assessment to determine the underlying cause. Getting confused and experiencing forgetfulness may be associated with normal aging changes.

Spermatogenesis

production of sperm begins to decline during the fourth decade and continues into the ninth. With men, testosterone levels decrease with age, sometimes leading to a loss of libido. Older women experience a reduced responsiveness of the ovaries to pituitary hormones and a resultant decrease in estrogen and progesterone levels. This may result in the woman having a decreased libido. Hormonal changes can also cause dryness of the vaginal mucosa, causing irritation and pain with intercourse and vaginal examination

Touch therapy

provides sensory stimulation, induces relaxation, provides physical and emotional comfort, conveys warmth, and communicates interest.

Dementia

generalized impairment of intellectual functioning that interferes with social and occupational functioning

apraxia

inability to perform particular purposive actions associated with dementia

Reminiscene Therapy

involves recollection of the past to help the patient understand the present situation and resolve current conflicts

Kyphosis

occurs in the older adult because of osteoporosis, which leads to a curvature of the thoracic spine

Dementia

A chronic, progressive cognitive decline Slow onset Duration = months to years cause = unknown, possibly familial, chemical reversibility = none management = treat signs and symptoms Nursing Intervention = reorientation is not effective in the late stages; use validation therapy; provide a safe environment; observe for associated behaviors such as delusions and hallucinations

Presbycupis

A common age-related change in auditory acuity. It affects the bones of the middle ear, typically bilaterally, and thus the ability to hear high-pitched sounds and conversational speech; the condition affects more men than women.

Reality orientation

A communication technique that helps to restore the sense of reality in an older adult. Makes them more aware of person, place, and time. The purposes include restoring a sense of reality, improving the level of awareness; promoting socialization; elevating independent functioning; and minimizing confusion, disorientation, and physical regression

Ritanopia

A form of color blindness in which a person is unable to tell the difference between blue and green, purple and red, and yellow and pink

Presbyopia

A visual acuity defect in older adults that occurs because of retinal damage, reduced pupil size, development of opacities in the lens, or loss of lens elasticity.

Which is a primary reason that older adults do not adhere to the prescribed dosing schedule for medications? A. They prefer using herbal medicine B. They forget the proper timing of the medication C. They are confused about medication dosages D. They are more prone to the adverse effects of medicines

D. rationale: One of the greatest challenges for older adults is safe medication use. Many medication categories, such as analgesics anticoagulants, antidepressants, antihistamines, antihypertensives, sedative-hypnotics, and muscle relaxants, create a high likelihood of adverse effects in older adults. They are at risk for adverse medication effects because of age-related changes in the absorption, distribution, metabolism, and excretion of drugs, collectively referred to as the process of pharmacokinetics. Examples of adverse effects include confusion, impaired balance, dizziness, nausea, and vomiting. Because of these effects, some older adults are unwilling to take medications; others so not adhere to the prescribed dosing schedule. Preference for herbal medicine, forgetting the proper timing of medications, and confusion related to medicine dosages are not the main reasons for avoiding adherence to a prescribed drug regimen.

Which statement made by a student nurse indicates effective learning regarding bone demineralization in men and women? A. "older men have a higher rate of fractures that older women do" B. "increased mobility in older men causes more bone demineralization" C. "bone density and bone mass start to declining after the age of 50 years" D. "older women have a greater rate of bone demineralization than older men"

D. rationale: Postmenopausal women have greater rate of bone demineralization than older men. Older women have a higher rate of fractures than older men. Decreased mobility in older men causes more bone demineralization. Bone density and bone mass start declining after the age of 30 years

Which condition is the result of a weakening of the perineal and bladder muscles in an older woman? A. Feeling the need to urinate despite having an empty bladder B. Burning sensation with urination C. flank pain D. Involuntary release of urine

D. rationale: Weakening of the perineal and bladder muscles leads to stress incontinence, an involuntary release of urine that occurs when the patient coughs, laughs, sneezes, or lifts an object. Feeling the need to urinate despite having an empty bladder is associated with a urinary tract infection, as are the symptoms of burning with urination and flank pain

Which assessment finding supports the nurse's suspicion that a patient has developed depression? A. disturbed affect B. difficulty finding words C. hypervigilant D. psychomotor agitation

D. rationale: an older adult with depression may experience psychomotor retardation or agitation. A patient with delirium may appear disturbed, whereas a patient with depression has a flat affect. A patient with dementia, not depression, has difficult finding words. A patient with depression experiences a normal level of alertness compared with a patient who has delirium and is lethargic or hyper vigilant

Which factor leads to an older adult experiencing difficulty distinguishing between the colors blue and black? A. glaucome B. malnourishment C. macular degeneration D. lens discoloration

D. rationale: changes in color vision may occur because of aging. the lens in the eye can become discolored, making it difficult to distinguish between dark colors, such as blue and black. Symptoms of glaucoma include loss of peripheral or side vision, seeing halos around lights, and vision loss. Vitamin and mineral deficiencies can accelerate vision loss caused by glaucoma, cataracts, and/or macular degeneration. Symptoms of macular degeneration include worse or less clear vision and dark, blurry areas in the center of the visual field

Which system is affected in periodontal disease? A. respiratory system B. neurological system C. genitourinary system D. gastrointestinal system

D. rationale: periodontal disease may occur as a physiological change in the GI system associated with aging. The respiratory system is characterized by increased cough reflex, decreased cilia, and fewer alveoli. Physiological changes in the neurological system include degeneration of nerve cells and degeneration of neurons, Physiological changes in the genitourinary system include decreased nephrons and decreased bladder capacity.

Which effect does reduced salivary secretion and taste bud atrophy have on an older adult? A. gum diseases B. mouth ulceration C. decrease in appetite D. inability to differentiate various tastes

D. rationale: reduced salivary secretion and taste bud atrophy occur because of aging, leading to the inability to differentiate amount salty, sweet, sour, and bitter tastes. Reduced salivary secretion and taste bud atrophy do not cause gum diseases, mouth ulceration, or a decrease in appetite.

Which cognitive-related change indicates the normal process of aging? A. poor judgment B. loss of language skills C. loss of the ability to calculate D. reduced number of brain cells

D. rationale: Reduction in the number of brain cells is a characteristic creature of the normal again process. Symptoms of cognitive impairment, such as poor judgement, loss of language skills, loss of the ability to calculate, and disorientation, are not normal aging changes and require further assessment of the patient for underlying causes.

The patient with delirium may demonstrate which behavior? SATA a. repeats words uncontrollably b. is distracted from the task assigned c. chooses not to answer questions d. frequently asks for feedback on performance e. makes numerous errors while performing an activity

b, e rationale: delirium, or acute confusional state, is an acute change in attention and awareness that develops over a relatively short time interval and is associated with additional cognitive deficits, such as memory deficit, disorientation, or perceptual disturbances. Inattention is a clinical feature of delirium, which includes getting distracted from the work assigned. Disturbed or reduced level of consciousness, fluctuating levels of alertness, and inattention contribute to errors while the patient is performing an activity. Perseveration of speech (repeating of words, phrases, or sounds) is a clinical feature of dementia. A patient with depression is preoccupied with personal thoughts and often chooses to not answer questions that are asked. Generally impaired orientation and a reduced level of consciousness often do not allow a patient with delirium to stay focused on a task; therefore, obtaining feedback does not occur

The nursing team leader correct which action by a nurse who is providing care for an older adult with dementia? SATA A. considers the patient's food preferences B. Provides limited choices with simple instructions C. Performs reminiscence therapy D. Attempts to reorient the person E. Focuses more on the task that needs to be accomplished than the interaction

d, e rationale: When dealing with a patient with dementia, the nurse should recognize and accept the person's reality. The nurse should not attempt to reorient the person; instead, the nurse should recognize that the person's behavior is a form of communication. The nurse should nurture authentic, caring relationships and focus more on the interaction than the task needing to be accomplished. The nurse should support the patient eating nutritious meals and should consider his or her food preferences. The nurse should provide limited choices with simple instructions. Psychosocial practices that may be beneficial include validation therapy, reminiscence therapy, music therapy, pet therapy, and meaningful activities.