Ch 33: Health Promotion and Care of the Older Adult

24. When an older female patient complains of painful sexual intercourse, the nurse recognizes that the probable cause is: a. urinary incontinence. b. arthritic joints. c. kyphosis. d. mucosal drying.

ANS: D Sexual intercourse may be uncomfortable because of drying of the mucosa of the vagina. REF: Page 1104 TOP: Reproductive alterations

39. The nurse recognizes that a term referring to mechanical difficulty of swallowing is .

ANS: dysphagia Dysphagia is a term that refers to mechanical difficulties in swallowing. DIF: Cognitive Level: ImplementationREF: Page 1092 TOP: Gastrointestinal alterations

37. When bathing an 80-year-old woman who lives on a farm, the nurse assesses brown macules on the patient's hands and forearms. The nurse recognizes these as .

ANS: lentigo Lentigo is a term that refers to brown-pigmented lesions on the skin of the older person who has spent a great deal of time in the sun. These macules are also called "age spots." REF: Page 1088 TOP: Integumentary alterations

38. The nurse initiates the application of a drawsheet on every bedfast patient on her unit to facilitate lifting and to prevent forces.

ANS: shearing Shearing forces cause skin damage by friction; for instance, when a patient is dragged across bed linens during a position change. REF: Page 1089 TOP: Integumentary alterations Step: Planning

13. The nurse suggests that to relieve the pain of claudication the patient should: a. rest. b. exercise. c. cross his legs. d. walk.

ANS: A A nursing intervention to relieve pain is to recommend the patient rest periodically until the pain subsides. The nurse could also suggest improving circulation progress by walking. REF: Page 1097 TOP: Circulatory alterations

35. When assessing the older adult, the nurse considers which aspect of the patient's routine as a possible contributor to constipation? a. Intake of antacids several times a day b. Taking a laxative once a week c. Excessive exercise routine d. Eating two apples a day e. Drinking 60 ounces of bottled water daily

ANS: A Intake of antacids is constipating. All other options decrease the risk of constipation. REF: Page 1093 TOP: Constipation Step: Assessment

14. The nurse recommends a breathing technique to help a patient with chronic obstructive pulmonary disease (COPD) to empty the lungs of used air and to promote inhalation of adequate oxygen. This method of breathing is: a. pursed-lip breathing. b. increased inspiration. c. vital capacity. d. decreased expiration.

ANS: A Pursed-lip breathing can help empty the lungs of used air and promote inhalation of additional oxygen. REF: Page 1098 TOP: Chronic obstructive pulmonary disease (COPD)

36. What should the nurse do to help the dysphagic patient? (Select all that apply.) a. Sit the patient upright. b. Reduce distraction during mealtime. c. Offer fluid from a straw. d. Thicken liquids. e. Cue the patient to swallow.

ANS: A, B, D, E Offering fluids using a straw increases the possibility of choking or aspiration. REF: Page 1092 TOP: Gastrointestinal alterations

9. The patient complains to the nurse about a newly developed intolerance to milk. The nurse suggests filling calcium needs with: a. rye bread. b. yogurt. c. apples. d. raisins.

ANS: B Lactose, primarily found in milk, is a common source of food intolerance. Dairy products are an important source of calcium, which is needed to prevent osteoporosis. Lactose-intolerant individuals need to replace milk with cheese and yogurt, which are processed and digested more easily. REF: Page 1092 TOP: Gastrointestinal alterations

3. The first major legislation to provide financial security for older adults was the Social Security Act passed in: a. 1930. b. 1935. c. 1940. d. 1945.

ANS: B The first major legislation to provide financial security for older adults was the Social Security Act of 1935. REF: Page 1086 TOP: Legislation

22. The postmenopausal woman asks the nurse about the risk of osteoporosis and how to find out if she is at risk. The nurse tells her the best test for this is: a. skeletal x-ray. b. bone density scan. c. calcium blood level. d. CAT scan.

ANS: B Bone density testing can identify women at risk for fractures. REF: Page 1102 TOP: Osteoporosis

1. When discussing aging, the nurse clarifies that the term older adulthood applies to those who are older than: a. 55. b. 65. c. 70. d. 75.

ANS: B Older adulthood begins at about age 65. REF: Page 1082 TOP: Aging

20. The nurse is assisting an older adult patient out of bed when suddenly the patient begins to fall. This could be caused by: a. fever. b. orthostatic hypotension. c. dehydration. d. a decrease in venous return.

ANS: B Orthostatic hypotension occurs when the patient changes position. In the older adult, the loss of elasticity in the vessels slows the vascular accommodation to sudden postural changes to a standing position. REF: Page 1115 TOP: Musculoskeletal alterations

11. The older adult female patient is concerned about incontinence when she sneezes. The nurse explains that this type of incontinence is called: a. urge incontinence. b. stress incontinence. c. overflow incontinence. d. functional incontinence.

ANS: B Stress incontinence results from sneezing, which causes increased abdominal pressure. REF: Page 1095 TOP: Incontinence

21. To help prevent falls related to muscle weakness, the nurse helps the patient select exercises that must be: a. done each day. b. muscle strengthening. c. weight-bearing. d. 1/2 an hour in length.

ANS: C Appropriate interventions to increase muscle strength begin with weight-bearing exercises. REF: Page 1115 TOP: Musculoskeletal alterations

6. At mealtime, the older adult seems to be eating less food than adequate. The nurse recognizes that the older adult compared to the younger adult requires: a. more fluids. b. less calcium. c. fewer calories. d. more vitamins.

ANS: C The older adult requires 30 calories per kilogram of body weight, whereas the younger adult requires 40 calories. REF: Page 1090 TOP: Gastrointestinal alterations

25. The nurse explains that as a result of loss of elasticity of the lens, an age-related vision change occurs called: a. nearsightedness. b. cataracts. c. presbyopia. d. blepharitis.

ANS: C Age-related changes include presbyopia and farsightedness resulting from a loss of elasticity of the lens. Cataracts are due to opacity of the lens. REF: Page 1105 TOP: Sensory alterations

33. Generalizing about decline of most functional aspects of the older adult, the nurse recognizes that one area that is not physically affected by age is: a. physical activity. b. productivity. c. cognition. d. sexuality.

ANS: C Aging has little influence on cognition. Only through disease processes is cognition altered. REF: Page 1108 TOP: Aging

29. The nurse reminds the family of a patient that the most common cause of dementia is: a. multi-infarct. b. medications. c. Alzheimer's. d. Parkinson's.

ANS: C Alzheimer's disease is the most common cause of dementia. REF: Page 1110 TOP: Dementia

4. When assessing the skin of an older adult patient who is complaining of pruritus, the nurse advises the patient that to reduce further drying of her skin, she should avoid using: a. perfumed soap. b. hard-milled soap. c. antibacterial soap. d. antiseptic soap.

ANS: C Antibacterial soap is very drying. REF: Page 1089 TOP: Integumentary alterations

10. The older adult patient complains to the nurse about nocturia. The nurse explains that the problem is most likely related to: a. loss of bladder tone. b. decrease in testosterone. c. decrease in bladder capacity. d. intake of caffeine.

ANS: C At least 50% of older men and 70% of older women must get up two or more times during the night to empty their bladders, a condition known as nocturia (excessive urination at night). The most significant age-related change is the decrease in bladder capacity. REF: Page 1094 TOP: Incontinence

15. The nurse reminds the 80-year-old patient that her respiratory system has decreased resistance to respiratory infections, making her more at risk for: a. COPD. b. bronchitis. c. pneumonia. d. atelectasis.

ANS: C Decreased resistance to respiratory infections causes older individuals to contract pneumonia. REF: Pages 1098-1099 TOP: Respiratory alterations

18. The nurse recognizes that arthritis affects an individual's functional ability. Interventions are aimed at relieving: a. pain and discomfort. b. formation of contractures. c. stress on affected joints. d. inflammation and scarring.

ANS: C Interventions for older individuals with arthritis are aimed at relieving stress on affected joints. REF: Page 1100 TOP: Arthritis

16. The nurse recognizes that an older adult patient with COPD has a higher incidence of developing which age-related skeletal change that will alter the ability to exchange air effectively? a. Osteoporosis b. Arthritis c. Kyphosis d. Osteomyelitis

ANS: C Kyphosis, usually caused by osteoporosis, is a curvature of the spine that alters respiration and air exchange. REF: Page 1097 TOP: Musculoskeletal alterations

30. While speaking to the family of an older adult patient with Parkinson's disease, the nurse states that there are positive aspects of Parkinson's, one of which is that: a. the disease does not alter ability to communicate. b. anti-Parkinson's drugs have few side effects. c. intellectual function is not impaired. d. involuntary movements can be controlled.

ANS: C Parkinson's disease does not impair the intellect. REF: Page 1112 TOP: Parkinson's disease

2. When the nurse discusses prevention of cardiac disease, falls, and depression with a group of older adults, it is important to stress the benefits of: a. nutrition. b. medications. c. exercise. d. sleep.

ANS: C Primary prevention stresses exercise for the prevention of cardiac disease, falls, and depression. REF: Page 1084 TOP: Health promotion

17. The nurse explains that the major difference between rheumatoid arthritis and osteoarthritis is that rheumatoid arthritis: a. is degenerative. b. affects patients over 40 years of age. c. is inflammatory. d. is curable.

ANS: C Rheumatoid arthritis is an inflammatory disease; osteoarthritis is degenerative. REF: Page 1100 TOP: Arthritis

31. The nurse reassures the family of a stroke victim that some of the neurological involvement associated with a cerebrovascular accident (CVA) may disappear within: a. 2 to 3 weeks. b. 1 to 2 months. c. 3 to 6 months. d. 6 to 9 months.

ANS: C Some of the initial neurological deficits of a CVA may disappear in 3 to 6 months. REF: Page 1112 TOP: Stroke

12. A change of aging related to the circulatory system includes decreased blood vessel elasticity, which leads the nurse to assess for: a. confusion. b. tachycardia. c. hypertension. d. retained secretions.

ANS: C The blood vessels become less elastic and may lead to increased blood pressure. REF: Page 1095 TOP: Circulatory alterations

32. When communicating with an older adult patient, the nurse becomes aware of the fact that the patient is well satisfied with his accomplishments over a lifetime and has no regrets concerning aging. The nurse recognizes that the patient has achieved the developmental stage identified by Erikson as: a. acceptance. b. withdrawal. c. ego integrity. d. interaction.

ANS: C The last stage of life is acceptance of life and results in ego integrity. REF: Page 1086, Box 33-4 TOP: Aging

8. When the nurse attempts to assist an older adult who is having difficulty swallowing, the nurse suggests a position in which the chin is held: a. parallel. b. upward. c. down. d. to the side.

ANS: C The upright position, leaning slightly forward with the chin down, improves swallowing with the assistance of gravity. REF: Page 1092 TOP: Gastrointestinal alterations

26. When communicating with an older adult patient who has difficulty hearing, the nurse should: a. speak very loudly. b. speak rapidly. c. lower the tone of the voice. d. raise the tone of the voice.

ANS: C To communicate with a patient with a hearing loss, the nurse should lower the tone of the voice. REF: Page 1107 TOP: Sensory alterations

34. When counseling the older adult patient about screening for preventive health, the nurse tells the patient that a complete physical for patients over 75 is recommended every: a. 2 years. b. 6 months. c. 3 years. d. year.

ANS: D A complete physical is recommended annually after 75. REF: Page 1084, Table 33-1 TOP: Health promotion

19. The home health nurse cautions the older adult patient that because of age-related changes in the musculoskeletal system, there is an increased risk for: a. fractures due to poor uptake of calcium. b. heart attacks due to increased effort to ambulate. c. respiratory failure due to kyphosis. d. falls related to posture changes.

ANS: D Falls are the leading cause of accidental death in individuals over 65, in part because of posture changes brought on by age. REF: Page 1114 TOP: Musculoskeletal alterations

23. When counseling a group of retirees, the nurse states that what percentage of newly diagnosed type 2 diabetic adult patients are middle-aged or older? a. 30% to 40% b. 40% to 50% c. 60% to 70% d. 85% to 90%

ANS: D Of adult diabetics, 85% to 90% have type 2 diabetes mellitus, which often begins in middle age. REF: Page 1103 TOP: Diabetes

7. The older patient informs the nurse that food has no taste and therefore she has no appetite. The nurse recognizes this is most likely caused by: a. tasteless food. b. overuse of salt. c. lack of variety. d. loss of taste buds.

ANS: D Older adults may experience a loss of appetite. Change in taste as a result of decreased saliva production and decreased number of taste buds may make food unappealing. REF: Page 1092 TOP: Gastrointestinal alterations

27. The nurse prepares the older adult patient with diabetes for which symptom of the disease that distorts tactile sensation? a. Proprioception b. Loss of visual acuity c. Progressive paresis d. Peripheral neuropathy

ANS: D Peripheral neuropathy is the presence of abnormal sensation. REF: Page 1103 TOP: Diabetes

5. Because thin skin and lack of subcutaneous fat predisposes the older adult to pressure ulcers, the nurse alters the care plan to include turning the bedfast patient every: a. shift. b. 4 hours. c. evening. d. 2 hours.

ANS: D Pressure ulcers can be avoided by repositioning every 2 hours. REF: Page 1089 TOP: Integumentary alterations Step: Planning

28. The nurse assesses a slowing of the impulse transmission in the nervous system that results in: a. hypertension. b. hearing deficit. c. decrease in tactile sensations. d. longer reaction time.

ANS: D When nerve impulses in the nervous system of an older adult slow down, the result is a longer reaction time. REF: Page 1108 TOP: Neurological alterations