Chapter 19 PrepU
The charge nurse in an extended-care facility knows that the new nurse understands ageism when she says which of the following?
"Neither intelligence nor personality normally decline because of aging." Explanation: Althought response time may be prolonged from a longer processing time, neither intelligence nor personality normally decreases because of aging. Loneliness results from losses, just as it does for people of all ages. Many adults are active in their communities. Incontinence is not a normal part of aging and requires medical attention. Older adults want to be attractive to others.
The nurse is evaluating a 42-year-old client who says that he is feeling stressed. Which of the following does the nurse know that could be a cause of stress for this age group?
Being caught in the sandwich generation Explanation: Middle-aged adults may be caught in a "generation sandwich," which includes involvement with children as well as aging parents and other family members. Retirement, the loss of driving privileges, and social isolation are often stressors for the older adult.
A gerontologic nurse practitioner has a large patient population with heart disease problems. This nurse practitioner is aware that heart disease is the leading cause of death in the aging adult. What is the cause of this trend?
Blood vessels lose their elasticity with age. Explanation: In the aging adult, the blood vessels become less elastic. Because the blood vessels become more rigid, increase in blood pressure can result. The body is less able to increase heart rate and cardiac output with activity.
When completing an assessment, especially of the older adult, the nurse knows the importance of including spiritual development. Older adults have completed moral development and many experience self-transcendence, which may be defined as what?
Capability to reach beyond prior limits with more awareness of other people's values and beliefs Explanation: Self-transcendence in the older adult may be described as the characteristic that helps one expand beyond personal limits, and to reach out to others with greater awareness of other people's beliefs and values. Past and future are more integrated into the present without regret or fear. Transcendence is a source of strength for the older adult faced with inevitable change and loss. The state of consciousness described is transcendental meditation.
An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition?
Delirium Explanation: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.
What term is used to describe various disorders that progressively affect cognitive function?
Dementia Explanation: Dementia describes various disorders that progressively affect cognitive function. Delirium is a temporary state of confusion that can last from hours to weeks and resolves with treatment. Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in a few members of their group. Reminiscence is the phenomenon of an older adult telling stories of the past.
A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client?
Depression Explanation: One sign of depression is a lack of interest in previously enjoyable activities. Further investigation is necessary to make a formal diagnosis.
Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process?
Encouraging a patient to have regular checkups Explanation: Gould viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60). The nursing action that best facilitates this process would be encouraging a client to have regular checkups.
The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what?
Generativity versus stagnation Explanation: The developmental task of the middle adult is "generativity versus stagnation." They are in a stage of guiding the next generation, accepting their own changes and adjusting to need of aging parents, as well as evaluating their own goals and accomplishments. "Initiative versus guilt" is the developmental task for toddlers. "Ego integrity versus despair" is the developmental task for older adults. "Goal attainment versus crisis" is not a developmental task.
A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning but has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation?
Hydromorphone Explanation: Hydromorphone is a narcotic agent which is often constipating in older adults. Psyllium helps promote regular bowel elimination. Acetaminophen is not linked to constipation. Furosemide is used as a diuretic. It does not cause constipation.
A male client reports chronic insomnia. Which medication would the nurse not want to administer to the client?
Nasal decongestant for an upper respiratory infection Explanation: Decongestants can worsen insomnia in the older adult.
A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism?
Personality is not changed by chronologic aging. Explanation: Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronologic aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age. Old age does not begin at age 65.
An 80-year-old client tells the nurse that he has been dizzy since starting to take an herbal remedy for arthritis in addition to prescribed medications. The nurse recognizes that the client may be experiencing the effects of which of the following?
Polypharmacy Explanation: Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Alternative therapies, such as herbal remedies, have the potential to interact with prescribed drugs. Fluid volume overload and sleep disorders are not the cause of dizziness. Cascade iatrogenesis is a sequence of adverse events in a frail, older adult.
There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult?
Sleep medications are usually the first choice in treating sleep disturbance. Explanation: Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.
A 90-year-old woman is admitted to a nurse's unit status post CVA. The client is alert and oriented to person, place, and time but has limited mobility and hemiparesis of the left side of her body. She is experiencing urinary incontinence. What is the most appropriate nursing action?
Use the Braden scale to assess for pressure ulcers. Explanation: The Braden scale is an evidence-based tool used to assess for pressure ulcers. Pressure ulcers can result from urinary incontinence, particularly if the skin is moist and skin integrity is impaired.
A nurse is preparing to medicate an older adult client with an opioid analgesic. Which of the following does the nurse consider in the use of this medication?
You selected: Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when pain is not managed adequately. Explanation: Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when pain is not managed adequately. Pain should not be assumed to be a normal consequence of aging but is often experienced by older adults and frequently is undertreated. Older adults are frequently prescribed lower doses of opioid analgesics than younger adults.
An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for:
suicidal thoughts. Explanation: Although poor cognitive performance, sleep problems, and lack of initiative are manifestations of depression, the nurse should be alert for indications of suicidal thoughts or behaviors. Suicide is the most serious consequence of depression.
A nursing student is studying the normal physiologic changes of older adults. The faculty member knows that the student comprehends the information when she says which of the following?
• "Height may decrease 1-3 inches." • "There is an increased sensitivity to glare." • "Fluids and electrolytes remain within normal ranges." Explanation: Normal physiologic changes of older adults include height may decrease 1-3 inches, there is an increased sensitivity to glare, and fluids and electrolytes remain within normal ranges. Rate of reflex responses decrease and the senses of taste and smell are decreased. Sweet and salty tastes diminish first.
Nurses who care for diverse populations must be aware of patterns of disease that are more likely to affect certain ethnic or racial groups. Which examples accurately reflect these profiles? (Select all that apply.)
• Black American men are 30% more likely to die from heart disease than non-Hispanic white men. • Hispanics have higher rates of obesity than non-Hispanic Caucasians. • Black Americans have the highest mortality rate of any minority for most major cancers. • Tuberculosis is 11 times more common in Asian Americans than the white population. Explanation: Several examples reflect correct information about particular ethnic or racial groups. Black American men are 30% more likely to die from heart disease than non-Hispanic white men. Hispanics have higher rates of obesity than non-Hispanic Caucasians. Black adults are diagnosed with diabetes and die from diabetes almost three times as often as white adults. Tuberculosis is 11 times more common is Asian American that the white population. Several examples were incorrect. American Indian/Alaska Natives have an infant mortality rate 60%, not 75%, higher than that of Caucasians. Black adults are diagnosed with diabetes and die from diabetes almost two times, not three times, as often as white adults.
A nurse is screening for Alzheimer's disease (AD) in patients in a long-term care facility. Which facts regarding AD are accurate? (Select all that apply.)
• Scientists estimate that more than 5 million people have AD. • Nearly half of 85-year-old adults have A • AD affects brain cells and is characterized by patchy areas of the brain that degenerate. Explanation: The following facts about Alzheimer's disease (AD) are correct. Scientists estimate that more than 5 million people have AD. Nearly half of 85-year-old adults have AD. AD affects the brain cells and is characterized by patchy areas of the brain that degenerate. The first indications of AD usually occur after 60 years of age. AD is a progressively serious and ultimately fatal disorder.
When caring for older adults, nurses must be aware of common conditions found in this population. Which statements accurately describe these conditions? (Select all that apply.)
• Sundowning syndrome is a condition in which an older adult habitually becomes confused, restless, and agitated after dark. • Depression is a prolonged or extreme state of sadness occurring in many older adults. • A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences. Explanation: Several of the statements listed are true statements. Sundowning syndrome is a condition in which an older adult habitually becomes confused, restless, and agitated after dark. Depression is a prolonged or extreme state of sadness occurring in many older adults. A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences. There were three statements that were not true. First, delirium is not a permanent state of confusion occurring in older adulthood. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment. Polypharmacy does not look at the number of pharmacies used to obtain prescriptions but the amount of drugs prescribed by health care providers for a variety of medical conditions. Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Complicated regimens need careful review to minimize risks and complications and maximize benefits.