Chapter 23

A nursing student is studying the normal physiologic changes of older adults. The faculty member knows that the student comprehends the information when the student makes which statements? Select all that apply.

"Height may decrease 1 to 3 in (2.5 to 8 cm)." "There is an increased sensitivity to glare." "Fluids and electrolytes remain within normal ranges."

An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address?

"I find myself napping on and off throughout the day."

A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states:

"I need to try and go to bed and get up at the same time each night."

The geriatric nurse is evaluating her orientee's understanding of the theories of aging. The nurse knows that the orientee understands when the orientee states which of the following?

"In the genetic theory of aging, cells become exhausted from continual energy depletion."

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."

A nurse is teaching an elderly client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following?

"Sundowning is a common problem of dementia."

A nursing student is studying depression in the elderly adult. Faculty members knows the student has mastered the information when she states which of the following?

"Treatment of depression includes counseling."

A nursing student is looking at the demographics related to the older adult and finds that what percentage of the older adult population that is institutionalized falls into the age range of 85+ years?

15.4%

In 2014, what percentage of older adults resided in long-term care facilities?

3%

The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client?

Alzheimer's disease

One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors?

Annual screening after the age of 50

A 79-year-old female is admitted to a long-term care facility. She is incontinent of urine and feces and has impaired cognition. What is the best nursing intervention to prevent skin breakdown for this resident?

Assist her to the toilet every 2 hours and after meals

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

Which factor contributes to sleep disturbances in older adults?

Beta-blockers

A gerontologic nurse practitioner has a large client 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.

The nurse is assessing a middle-aged adult age 48 years in the clinic. The nurse recalls the changes that occur in middle age as they complete the physical and cognitive examination. Changes that occur include what?

Cardiac output decreases.

Most older adults gradually modify activities or lifestyle to accommodate for declines in strength and health. The nurse recognizes the need for older adults to maintain activity and exercise in order to preserve all physiologic functions. When encouraging activity, it is important to consider which of the following? Select all that apply.

Chronic illness often accompanies aging. There is an increased risk of sleep disorders. Assistive devices help to maintain mobility and safety.

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?

Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when pain is not managed adequately.

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

A nurse is reading a journal article about mood disorders in the older adult population. Which information about these conditions would the nurse expect to find? Select all that apply.

Depression is often misdiagnosed. Symptoms often mimic those of other chronic comorbidities of the older adult. Suicide is the most serious consequence of depression.

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 client to have regular checkups

Erikson identified ego integrity vs. despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older clients' ego integrity?

Encouraging life review

An older adult client's daughter asks if the doctor can prescribe an antipsychotic medication for her father because he is so confused and agitated much of the time. The nurse is aware that the client should only be prescribed this medication when which strategy has failed? Select all that apply.

Environmental Behavioral Social

An older adult client comes to the clinic for his yearly influenza vaccination. During the visit he asks the nurse, "I've heard about this other vaccine for pneumococcal pneumonia. How often do I need to get this vaccine?" The nurse would encourage the client to receive this vaccination at which frequency?

Every 5 years

An elderly client is becoming progressively confused due to Alzheimer's disease. The family can no longer manage the client at home due to wandering. Which of the following living arrangements could the nurse recommend?

Extended-care facility

A group of nursing students is reviewing information about the older adult and mobility. The students demonstrate a need for additional study when they identify which statement as accurate?

Falls are the leading cause of death due to injury in individuals who are over the age of 75 years.

Which of the following health promotion measures should occur most frequently in older adult women?

Fecal occult blood test

A nurse is assessing a 55-year-old female client. What is a normal physical change in the middle adult? Select all that apply.

Hearing acuity diminishes. Cardiac output begins to decrease. There is a loss of calcium from bones.

An older adult client comes to the senior center for a check-up. During the visit, the client tells the nurse that he knows he should be more active than he is. The nurse reinforces the client's statement, explaining that physical activity helps to lower the risk of which condition? Select all that apply.

Heart disease Stroke Diabetes

Based on Havighurst's theory of human development, which nursing intervention would best facilitate the accomplishment of a developmental task of older adulthood?

Helping a client move independently using a walker

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?

Hydroporphone

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory?

Identity-continuity theory

When assessing a client during the middle adult years, the nurse recognizes which of the following as a normal physical change?

Increased loss of calcium from the bones

When completing an assessment of the middle-aged adult, the nurse makes note of the client's cognitive development. Then nurse would expect to find what?

Increased motivation to learn.

A nurse is assessing middle-age adults living in a retirement community. What behavior would the nurse typically see in the middle-age adult?

Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community

The nurse practitioner is examining a 55-year-old female client. Which of the following findings would be uncommon for this age group?

Lower extremity pulses are weak

A nurse is preparing a presentation for families who are caring for older adults at home. Which information would the nurse most likely include about an older adult's cognition?

Many older adults retain full cognitive function into advanced age.

The older population, persons 65 and older, numbered over 43 million in 2012. There are limited resources to care for this aging population. Factors that influence society's attitude to this age group include which of the following myths?

Old age begins at 65. Most older adults live in nursing homes. The majority of senior citizens are not in good health. Loneliness and isolation are problems associated with this age group.

A nurse is preparing an in-service presentation for a group of nurses who work with older adults. The nurse would include which finding associated with this population? Select all that apply

Older adults living with a spouse decreases with age. Most older adults are satisfied with their life There are three times as many widows as widowers.

A healthy 52-year-old client asks the nurse what she can do to maintain her health. Which of the following does the nurse recommend?

Perform self-examination of the skin every month

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.

The home care nurse is visiting an older adult client in the home to assess a leg wound and change the dressings. The nurse is aware that the client receives money monthly but there is no food in the house, no adequate heat, and the client states, "My sister takes my check and cashes it every month." What is the correct action by the nurse?

Report the incident to social service informing them the client has no food or heat.

An 85-year-old client's daughter calls the nurse and states her father is recently having periods of confusion, is unable to dress himself, and is having periods of incontinence. Which of the following should the nurse do first?

Schedule an appointment for a physical examination

In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client?

Sleep deprivation

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.

SPICES assessment

Sleep, problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown.

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence?

Stress

Which activity performed by an older adult client would make the client's family suspicious of the onset of dementia?

The client is an accountant and has had three episodes of bookkeeping errors.

Which of the following assessment findings of a male client age 77 years should signal the nurse to a potentially pathologic finding, rather than a normal age-related change?

The client is oriented to person and place but is unsure of the month.

After obtaining the health history from an older adult client, the nurse develops a plan of care and identifies the client has impaired physical mobility. What information would support this impairment? Select all that apply.

The client states that he or she must use a walker for stability. The client states the hip and knee joints hurt and are stiff when ambulating. The client reports weakness on one side of the body following a stroke.

A nurse is preparing a presentation for a group of older adults about health promotion. Which statistic would the nurse need to keep in mind about this group?

The group experiencing the largest growth is those 85 years of age and older.

When providing nursing care to the elderly, it is most important to provide comfort due to which of the following changes?

Thermoregulation

A nurse is providing care to an older adult with moderate cognitive impairment. When interacting with the client, which actions would be most appropriate? Select all that apply.

Use short, simple words when conversing with the client. Call the client by name.

Which group of individuals in the older adult population is most likely to be widowed?

Women over the age of 75

An older adult client tells his home care nurse that he doesn't seem to sleep as well as he used to. The nurse is aware that the sleep changes that occur in the older adult client which cause a less restful sleep include:

a decrease in the deep sleep stage of the sleep cycle.

A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as:

abandonment

The nurse is caring for a client diagnosed with dementia. Which behaviors would the nurse most likely assess? Select all that apply.

asking questions repeatedly socially inappropriate behavior wandering irritabilty

When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply.

decline in humoral immunity lowered antibody responses inadequate nutrition

An older adult client tells the nurse, "I just don't seem to have an appetite and food just doesn't taste as good as it used to." The nurse understands that which factor may be playing a role in this client's lack of appetite? Select all that apply.

decreased number of taste buds decreased saliva production

What term is used to describe various disorders that progressively affect cognitive function?

dementia

When the home care nurse visits a female client age 78 years who is recently widowed, the nurse finds that the home is cluttered with trash. The client appears sad and disheveled. The nurse should assess the client for symptoms of:

depression

The nurse is caring for an older adult client on the medical unit admitted for diagnostic testing. He is alert and oriented and lives independently in his own home. Which nursing intervention will be most effective in the prevention of falls for this client?

ensuring his glasses are close by his bed

A nurse is reviewing the medical records of clients at a long-term care facility who are experiencing weight loss. The clients' medical conditions have been ruled out as a cause. The nurse understands that which situation would most likely be a factor? Select all that apply.

evidence of depression use of appetite-suppressing drugs need for staff to assist with meals

A nurse is performing a home assessment for a 90-year-old widower who lives in a third story apartment. As the nurse considers his home environment, the nurse knows that the greatest risk of injury-related death or disability for the client comes from:

falls

After graduation, if you especially want to care for the aged population, you would consider the nursing specialty that focuses on the health and illnesses of the aging. This specialty is:

gerontologic nursing.

An older adult client is prescribed a sleep medication. When explaining the medication to the client, the nurse would emphasize which aspect of therapy?

greatest effectiveness with short term use

29s A nurse is caring for a 46-year-old male client who is being treated for depression following the death of his spouse. Which action best facilitates the accomplishment of a developmental task of this middle adult?

helping him to see the value of guiding his children to become responsible adults

When the older adult faces illness, the greatest threat to health is:

loss of physiologic reserve of the organ systems.

A nurse is preparing a presentation for a group of older adults about promoting safety while maintaining their mobility. Based on the nurse's understanding of factors placing the older adult at risk for falls, which area would the nurse most likely address? Select all that apply.

medication use diminished strength environmental hazards

A home care nurse is making a home visit to a 78-year-old client being cared for by his son and daughter-in-law. The client has missed several follow up visits to the health care provider over the past several months. The client states, "My son is so busy. I don't want to bother him." When the nurse asks the son about the missed visits, the son replies, "He just saw the doctor a couple months ago. He doesn't need to see him again. Besides, it costs too much money." The nurse would suspect:

neglect

A nurse is providing care at an ambulatory care center to a wide range of older adults from diverse racial and ethnic groups. Based on recent statistics, which group would the nurse most likely identify as projected to be the largest?

non-hispanic whites

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?

poly pharmacy

A 72 year old client often actively engages in reminiscence when the nurse is delivering care. The nurse recognizes that:

reminiscence is a normal process in achieving ego integrity.

The student nurse is conducting an informal study on pain management in the older adult population in a local long-term care facility. Which older adult client population will the student most likely find to receive the least effective pain management?

residents 85 years or older

Changes in T-cell function in older adults will result in:

risk of infection

The nurse is assessing an older adult client who is having difficulty with mobility. Assessment reveals that the client has stiff and awkward muscle movements. The nurse identifies this as:

spasticity.

An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for:

suicidal thoughts

Based on an understanding of the cognitive changes that normally occur with aging, what might the nurse expect a newly hospitalized older adult to do?

take longer to respond and react

A nurse is counseling the caregivers of an older adult male. The caregivers feel that they want to do everything to prevent hospitalization of their loved one. Which of the following can the nurse recommend? Select all that apply.

vitamin D supplementation daily exercise throw rugs with nonslip backing