Ch. 24: Older Adult

19. A man tells a nurse that he is concerned about his risk of developing cancer. Which of the following behaviors would place the man at higher risk of developing cancer? a. Smoking a half of a pack of cigarettes a day b. Exercising three times a week c. Consuming green, leafy vegetables several times a week d. Visiting a chiropractor every week

ANS: A Habits that place older adults at a high risk for developing cancer: not following nutritional guidelines, high stress levels, not engaging in a regular exercise program, and smoking cigarettes and using other tobacco products.

2. Which of the following statements made by a client best identifies someone who would benefit from health promotion interventions? a. "I have a new grandchild and want to be part of her life." b. "My mother lived until she was 90, so a long life is in my genes." c. "Some chronic illness is just a part of aging." d. "I hope I'll live a lot longer, but one never knows."

ANS: A Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling that illness is just part of aging or leaving health up to chance will not help the person make necessary lifestyle changes.

16. A nurse is conducting a home visit for an older adult in the summer. Which of the following items should the nurse should locate in the home? a. Fan b. Porch chair c. Synthetic blend clothing d. Thermometer

ANS: A Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air. Light-weight cotton clothing "breathes" and facilitates cooling, whereas synthetic material retains heat.

10. Which of the following individuals would be at greatest risk of injury? a. 80-year-old who does not have air conditioning or a fan b. 70-year-old who has new dentures c. 68-year-old who has difficulty tasting salt in food d. 84-year-old who needs hearing aids

ANS: A Sweating decreases in older adults, predisposing them to heat stroke.

5. A nurse is conducting a community health education program about osteoporosis with a group of older adults. Which of the following individuals in attendance is at greatest risk for developing osteoporosis? (select all that apply) a. 65-year-old Asian woman who smokes one pack of cigarettes per week b. 80-year-old White man who has three glasses of wine per day c. 74-year-old White woman on daily oral prednisone for emphysema d. 68-year-old Black man who has a sedentary lifestyle

ANS: A, B, C Osteoporosis is a disease of bone loss common to women age 70 and older and men age 80 and older. The disease occurs six times more frequently in women than it does in men. Risk factors include a small, thin frame; White or Asian ancestry; family history; excessive thyroid medication or high doses of cortisone-like drugs for asthma, arthritis, or cancer; a diet low in dairy products and other sources of calcium; physical inactivity; smoking cigarettes; and drinking alcohol.

6. An 80-year-old person is admitted to the hospital. During the health assessment process, which of the following conditions should the person be screened for by the nurse? (select all that apply) a. Polypharmacy b. Kidney failure c. Illegal drug use d. Alcoholism

ANS: A, B, C, D Alcoholism and illegal drug use are often overlooked by health care professionals because of a person's age. Many older adults take multiple over-the-counter and prescription medications and are at risk for drug interactions.

4. Which of the following nursing interventions implies respect for a person's spirituality? (select all that apply) a. Changing the position of the bed in a Muslim client's room so that it faces east b. Contacting the chaplain to assess the client's spiritual needs c. Saying a silent prayer with a client at the client's request d. Praying out loud in the room of a dying client

ANS: A, C Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by the nurse is needed to allow the person in any setting to achieve spiritual health. The nurse can provide an environment that is supportive to the practice of the person's spirituality. Praying out loud does not demonstrate respect for a person's spirituality but imposes the nurse's belief system on the person. Nurses should be able to assess the person's spirituality initially and determine if it is necessary to further consult the chaplain.

5. Which of the following nursing diagnoses is a priority related to the problem of urinary incontinence? a. Risk for social isolation b. Risk for impaired skin integrity c. Risk for inadequate fluid intake d. Risk for impaired coping

ANS: B Although social isolation and decreased fluid intake may occur because of urinary incontinence, impaired skin integrity is a major concern because of its impact on physical and psychological health.

20. Which of the following statements is the best definition of polypharmacy? a. The use of more than five medications prescribed by different physicians b. The use of multiple medications for the same or different health problems c. The use of multiple pharmacies and self-management of medications d. The use of multiple medications and supplements simultaneously

ANS: B Polypharmacy is the use of multiple medications for the same or different health problems. It is a major concern for elderly people, with the rate of polypharmacy in this population being between 9% and 39%.

14. The clinic nurse has seen the following four people today. Which of the following people is demonstrating a healthy coping pattern? a. Discusses very little except the loss of her husband 3 years ago b. Talks about the "good times" she and her husband had before his illness and death 1 year ago c. States that life is not worth living without her husband, who died 2 years ago d. Blames herself for her husband's death because she did not "make him go" to the doctor ANS: B Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects on coping, whereas positive reappraisal has a positive effect.

ANS: B Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects on coping, whereas positive reappraisal has a positive effect.

24. A woman who is being discharged from the hospital is oriented to person, place, and time, and her memory is intact. She has occasional forgetfulness without a consistent pattern of memory loss. Which of the following housing options would be most appropriate for this woman? a. Independent living b. Retirement community c. Assisted living d. Nursing facility

ANS: B Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact, but has occasional forgetfulness without a consistent pattern of memory loss. Independent living may be appropriate for the person if she had a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression.

1. Which of the following interventions will have the greatest impact on reducing constipation in older adults? (select all that apply) a. Offering pureed foods that are easy to digest b. Encouraging fluids between meals c. Administering laxatives on a daily basis d. Assisting with ambulation

ANS: B, D Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid intake, can stimulate the colon and resolve constipation. Pureed foods do not contain adequate fiber. Increased fluid intake and exercise should be implemented before relying on medication to relieve constipation.

2. A nurse has accepted a position as director of health services in a retirement community. Which of the following statements about retirees is important for the nurse to consider as she plans programs? (select all that apply) a. Depressed and inactive. b. Left their job to spend more time with family. c. Left their job because of ill health. d. Happy and well-adjusted to retirement.

ANS: B, D Research has demonstrated that the majority of retirees are in good health and happy with their decision to leave work so as to spend more time with their families.

11. According to Erikson's theory of development, which of the following older adults has successfully navigated the stage of ego integrity versus despair? a. 72-year-old man who is reluctant to retire because "work is everything to me" b. 78-year-old woman who has scheduled her third face lift c. 80-year-old man who has informed his children that he has made his funeral arrangements d. 67-year-old woman who is depressed because she has not been promoted at work for the past 10 years

ANS: C Successfully navigating the stage of ego integrity versus despair requires that the individual accept normal bodily changes associated with aging, find meaning in life apart from work, accepts the inevitability of death, and is at peace with his or her life.

23. A community health nurse is working with a diverse population of older adults within the community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse when working with this diverse population? a. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. b. Hispanic older adults tend to rate their health as poorer than other ethnic groups. c. Older adults who tend to rate their health as fair or poor are also financially poor. d. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs.

ANS: C The National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic groups regarding their health status, their perceived need for assistance with routine needs, and the need for assistance with activities of daily living. In all groups, those who described their health as fair or poor were also more likely to be financially poor.

13. A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements would most likely be made by the nurse? a. "The desire for sexual intimacy declines rapidly with age." b. "Older adults are very well-informed about sexuality." c. "Older adults need to practice safe sex." d. "The danger of contracting STDs during sexual intimacy is extremely low in older adults."

ANS: C The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern in all age groups.

1. A nurse is planning to write a grant for a health promotion project in the community. Which of considerations should the nurse make when determining the appropriate population for this project? a. The fastest growing population is children under the age of 12. b. The fastest growing population is young Black American adults. c. The fastest growing population is White middle-age adults. d. The fastest growing population is non-White older adults age 65 and older.

ANS: D Adults age 85 and older are the fastest growing population in the United States, and the percentage of White Americans greater than age of 65 is decreasing compared with other ethnic groups.

3. Which of the following statements concerning nutrition and older adults is true? a. Older adults who live in their own homes are more likely to be malnourished than older adults living in a nursing home. b. Older adults lose their desire for high-fat, salty foods. c. Meals served in long-term care institutions are usually more well-balanced than foods eaten by older adults living at home. d. Many older adults are not aware of food assistance programs.

ANS: D Barriers that may interfere with the ability of independent seniors to obtain adequate nutritional food include limited transportation, income, and social support resources. Many older persons are unaware that they are eligible to participate in SNAP. The percent of older adults who live in their own homes and are malnourished is lower than that of older adults who live in a nursing home. Older adults do not lose their desire for high-fat, high-cholesterol, high-sodium foods. Fresh fruits and vegetables are not always available for older adults living in nursing homes.

6. A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of the following responses should be made by the nurse? a. "Older adults need as much sleep as middle-age and younger adults. Let's talk about your sleep patterns." b. "I'll ask the nurse practitioner to prescribe a sleeping pill for you." c. "Taking naps during the day can help relieve excessive fatigue and will help you sleep better." d. "Let's talk about your sleep schedule and things that may prevent you from getting a restful night's sleep."

ANS: D Nurses should assist older adults in achieving a good night's sleep through assessment that might reveal possible causes of sleep disturbances. Older adults need less sleep than younger adults. Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not the initial therapy choice because of side effects.

17. The community health nurse has obtained a grant to offer a "Safe Driving" series for older adults. Which of the following information should the nurse stress during the series? a. Traffic fatalities involving older adults occur mainly at dusk. b. The cause of two-vehicle accidents is frequently an older driver striking another car. c. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in accidents. d. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident.

ANS: D Traffic fatalities involving older adults occur mainly during the daytime. The cause of two vehicle accidents is frequently a younger driver striking the car driven by an older adult. The average blood alcohol level in older adults involved in accidents is lower than the blood alcohol level of younger drivers involved in accidents.

18. As part of a community-wide flu vaccination program for older adults, the nurse is assisting at a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine? a. "Do you have any food allergies?" b. "Have you had the pneumococcal vaccine?" c. "Have you had the flu in the past 5 years?" d. "Do you have Medicare?"

ANS: A An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells.

12. A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and 12 because the children's parents died in a car accident. Which of the following are priority nursing interventions that the nurse can implement to help the grandparents cope with the responsibility of raising their grandchildren? a. Connecting them with the "Grandparents Raising Grandchildren" support group b. Encouraging them by reinforcing how they successfully raised their own children c. Volunteering to provide respite time for them as needed d. Assuring them that their stress level will lessen as they gain confidence

ANS: A Stress experienced by grandparents who must raise grandchildren can be lessened by counseling and participation in support groups.

8. A nurse has recently accepted the position of unit nurse manager on a long-term care unit. Which of the following directives should the nurse give to the staff nurses? a. Encourage residents to participate in unit activities such as Scrabble™ and bingo. b. Demonstrate the caring aspect of nursing by dressing residents before breakfast. c. Fill in "missing words" during conversation with the residents to avoid embarrassment. d. Instruct the aides to get residents ready for breakfast as quickly as possible to make sure they are ready to eat.

ANS: A To encourage cognitive health nurses should inspire older individuals to take classes, read, engage in stimulating conversation and entertainment, keep their minds active, and continue learning throughout their lives. They are encouraged to continue with self-care activities rather than relinquish them to caregivers. Residents should be encouraged to perform self-care activities themselves. When help is required, it should be provided in an unhurried manner. Filling in missing words makes the resident dependent on the staff and reduces motivation to communicate, and the words supplied may not be the intended words.

3. The nurse working in a retirement community for older adults is conducting a psychosocial assessment of all residents. Which of the following questions should the nurse ask during the assessment process? (select all that apply) a. "Have you thought about harming yourself?" b. "Are you still playing bridge every Thursday?" c. "How does your congestive heart failure affect your life?" d. "Has your financial situation changed since last year?"

ANS: A, B, C Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to, depression. Economic difficulty is not a predictor of suicide in older adults.

7. A nurse is conducting a community education program about cognition in older adults. Which of the following information should be included? a. Some form of mild dementia is a normal part of aging. b. All forms of dementia have the same symptoms, but progress at different rates. c. Assessment for dementia should be part of routine physical exams. d. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not likely to have a cognition problem.

ANS: C Cognitive alterations are key symptoms that indicate changes in physiological function among older persons. Thus, assessment of cognition is an important part of routine assessments. Dementia is not a normal part of aging. Dementia symptoms vary according to the specific type of dementia. A score of 23 or lower on the MMSE indicates a problem with cognition.

4. Which of the following statements concerning urinary incontinence is correct? a. Urge incontinence occurs when one has the urge to void but is unable. b. Stress incontinence is associated with emotional turmoil. c. Functional incontinence occurs is associated with environmental barriers. d. Incontinence with high post-void residual occurs when someone laughs or sneezes.

ANS: C Functional incontinence is associated with environmental barriers, physical limitations, or cognitive impairment in which the client is unable to reach the toilet. Stress incontinence occurs when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void once the urge to void is felt. Urge, mixed, or stress incontinence with high post-void residual is caused by physiological changes that affect voiding, such as an enlarged prostate gland.

15. A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain from a chronic neurological disease. The man asks the nurse to please help him leave this world so that his suffering ends. Which of the following actions would be most appropriate for the nurse to take? a. Assist the doctor with the man's request b. Refuse to care for the man c. Contact the pain care specialist d. Provide the man with names of doctors who participate in assisted suicide

ANS: C Nurses caring for chronically ill older adults have the added responsibility of determining who is at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible and free of pain through the use of pharmacological and nonpharmacological interventions. Refusing to care for the man could be construed as abandonment and is not necessary. Consulting a pain care specialist is the correct action.

22. The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice program, so he can help his father decide if the program would be of benefit to him. Which of the following responses should be given by the nurse? a. "At hospice, your father will be heavily medicated, so he will not have pain." b. "All of your father's care will be provided by nurses at hospice." c. "Hospice care can take place either at home or in a hospice facility." d. "Visiting hours are about the same at hospice as they are here in the hospital."

ANS: C Once the person is placed in hospice care, treatment to relieve pain and other symptoms is continued by the physician after they have decided to end all curative treatment. Hospice care can occur in the home, a hospice inpatient facility, nursing home, and acute care hospital. The focus of hospice care is to help the person remain alert but free of pain. Families are encouraged to participate in care giving. There are no restrictions to visiting hours.

21. A person is preparing to return home following a 2-week hospital stay for congestive heart failure and pneumonia. Which of the following referrals would be most beneficial for the person? a. Transportation assistance b. Home-delivered meals c. Adult day care d. Home health nursing

ANS: D Home care nurses provide health care information and services to individuals and families. The resources available to community health nurses frequently are rich and enable the nurses to draw on a variety of sources to assist in promoting the health of community-dwelling older adults. Although all of the referrals listed may be of benefit to the person, the home health nurse will provide the most comprehensive services and be able to connect the person to necessary community resources.

9. A nurse is assisting with development of menu items at a long-term care facility. Which of the following menus would the nurse most likely recommend? a. One egg over easy, one slice of whole wheat toast with sugar-free jam, 4 oz orange juice b. 5-oz cheeseburger cooked medium well with lettuce and tomato, 10 baked potato chips, and 1 cup of decaf coffee with low-fat milk and artificial sweetener c. Chef salad with 2 oz each ham and turkey, lettuce, tomato, bean sprouts, onion, green pepper with low-fat dressing, and one small roll with low-fat spread d. Turkey bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips, and ice tea with artificial sweetener

ANS: D The United States Department of Agriculture recommends that infants and young children, pregnant women, older adults, and those who are immune compromised should not consume raw (unpasteurized) milk or any products from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, or raw sprouts.