Chapter 23 Older Adult
An adult child accompanies an older adult client to the clinic and states, "I am not sure what is going on with my parent but I think it is depression." What questions should the nurse ask the client to determine if he or she is depressed? Select all that apply.
"Have you lost interest in things you previously found pleasurable?" "Have you had any changes in weight recently such as a gain or loss?" "Can you tell me what your sleep patterns are?" Extreme or prolonged sadness in an older adult may be a warning sign of depression. Depression is not a normal part of aging. Death of a spouse or friends and changes in living environment and financial resources can precipitate feelings of grieving that, if unresolved, may result in depression. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression, such as sleep disturbances, weight loss (sometimes gain), difficulty with concentration, irritability or anger, loss of interest in once pleasurable activities, vague pains, crying, fatigue, and suicidal thoughts or preoccupation with death. Visual hallucinations are not part of the symptoms of depression and may be indicative of another form of mental illness or have an organic cause. Finding out what foods the client eats does not ask a question that relates to finding out if the client is depressed.
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 caring for patients in a primary care setting refers to Erikson's theory that middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which patient statement is an example of this finding?
"I spend all of my time going to the doctor to be sure I am not sick."
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 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 common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.
A nurse is caring for an 80-year-old patient who is living in a long-term care facility. To help this patient adapt to the present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence?
"Tell me about how you celebrated Christmas when you were young."
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." Treatment of depression usually involves psychotherapy or counseling along with antidepressant medication. In an older adult, hopelessness rather than sadness is more often associated with suicidal intent. Depression usually does not resolve without treatment and is frequently underdiagnosed. There is usually a distinct change of behavior accompanied by other specific signs and symptoms 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 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."
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 men in America are 30% more likely to die from heart disease than non-Hispanic White men. * Hispanics have higher rates of obesity than non-Hispanic Whites. * Black adults in America have the highest mortality rate of any minority for most major cancers. * Tuberculosis is 11 times more common in Asians in America than Whites.
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
A older adult client is admitted to a nurse's unit with a community-acquired pneumonia requiring 14 days of intravenous antibiotic treatment. What does the nurse identify to the client as a contributing factor that affects the older adult client? Select all that apply.
* Humoral immunity declines. * Older adults are more susceptible to pneumonia following respiratory infections.
A older adult client is admitted to a nurse's unit with a community-acquired pneumonia requiring 14 days of intravenous antibiotic treatment. What does the nurse identify to the client as a contributing factor that affects the older adult client? Select all that apply.
* Humoral immunity declines. *Older adults are more susceptible to pneumonia following respiratory infections.
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.
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 the hip and knee joints hurt and are stiff when ambulating. * The client states that he or she must use a walker for stability. * The client reports weakness on one side of the body following a stroke.
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'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.
*Behavioral *Environmental *Social
A nurse is caring for older adults in a senior adult day services (ADS) center. Which findings related to the normal aging process would the nurse be likely to observe? Select all that apply.
A patient with skin pigmentation caused by exposure to sun over the years A patient healing from a hip fracture that occurred due to porous and brittle bones Bruising on a patient's forearms due to fragile blood vessels in the dermis
A nurse is helping to prepare a calendar for an older adult patient with cognitive impairment. What is the leading cause of cognitive impairment in old age?
AD
An experienced nurse tells a less-experienced nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have "outlived their usefulness." What is the term for this type of prejudice?
Ageism
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 Colorectal screening annually after the age of 50.
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
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 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.
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. 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 educating the middle-age adult, it is important to discuss which of the following?
Calcium replacement Weight-bearing activity is important for both men and women to overcome bone mass losses.
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.
A nurse providing health services for a 55 plus community setting formulates diagnoses for patients. Which of the following nursing diagnoses would be most appropriate for many middle adults?
Caregiver Role Strain
A client aged 88 years who lives alone experiences dizziness caused by blood pressure medication. What intervention would the nurse prioritize in teaching this client?
Change positions slowly. The client should change positions slowly to minimize the possibility of dizziness. The client should not stop taking the medication. Increasing water and sodium intake could increase blood pressure. The effects of chronic illness and medications may also make the older adult more prone to accidents.
In regard to lifespan considerations, the most important functional health pattern to assess in the elderly client is
Cognition-perception Aging affects both cognition and perception.
A nurse caring for adults in a provider's office researches aging theories to understand why some patients age more rapidly than others. Which statements describe the immunity theory of the aging process? Select all that apply.
Decrease in size and function of the thymus results in more infections. There is much interest in the role of vitamin supplementation.
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 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.
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 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 client to have regular checkups 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.
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 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 84-year-old client has returned from the postanesthesia care unit. The client is oriented to name only. The client's family is very upset because before having surgery the client knew the family. The client is diagnosed with delirium. Which action should the nurse take to help the family with their emotions?
Explain that delirium is a state of confused thinking and usually lasts only a short time. By explaining what delirium is and that it usually is short-term provides the family with information that can decrease the family's worry. The hospital chaplain may help to provide emotional support but not all people are interested in religious counseling. The health care provider can be a good resource for information but the nurse should provide teaching to alleviate family concerns. It is not the nurse's place to coordinate a family meeting.
A nurse caring for older adults in a skilled nursing home observes physical changes in patients that are part of the normal aging process. Which changes reflect this process? Select all that apply.
Fatty tissue is redistributed. The skin is drier and wrinkles appear. Visual and hearing acuity diminishes.
Which of the following health promotion measures should occur most frequently in older adult women?
Fecal occult blood test
A 78-year-old woman is on a nurse's rehabilitation unit status post a cerebrovascular accident (CVA). As the nurse assess her gait, the nurse notices that the client's left foot is dragging and she is not bending her left knee nor swinging her left arm. How would the nurse best describe the client's gait?
Hemiparesis Hemiparesis is weakness on one side of the body.
Mrs. Jimenez, age 79, became a widow earlier this year and now resides alone in the house that she and her husband shared for 30 years. Her children have encouraged her to move, but she expresses a desire to remain in her home, despite some slight mobility challenges. The nurse who provides occasional home healthcare for Mrs. Jimenez should first propose which of the following?
Home modification Older adults typically express a desire to maintain their existing living relationships and this should be facilitated as long as it is safe. Consequently, the nurse should prioritize Mrs. Jimenez's wishes. Home modification may allow her to maximize her independence and maintain her current living situation in spite of some mobility challenges.
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 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 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
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 The identity-continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified worldwide. Disengagement theory maintains that older adults often withdraw from usual roles and become more introspective and self-focused. This withdrawal was theorized as intrinsic and inevitable, necessary for successful aging, and beneficial for both the person and for society.
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 male client reports chronic insomnia. Which medication would the nurse not want to administer to the client?
Nasal decongestant for an upper respiratory infection Decongestants can worsen insomnia in the older adult.
A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults?
Old age means mental deterioration.
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.
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. 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.
Following a fall that left an older adult temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply.
P—Problems with feeding C—Confusion S—Skin breakdown
An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be?
Remind him of where he is and assess why he is having difficulty sleeping. Reminding the client where he is will help orient him to his surroundings. Assessment is needed to determine any need that may be disturbing the client, such as the need to use the bathroom, feeling cold/warm, etc. The other responses do not include orienting the disoriented/confused client.
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.
A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism?
Speaking to older adults with the presumption that they have mild cognitive deficits
A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism?
Speaking to older adults with the presumption that they have mild cognitive deficits Accommodation of normal, age-related changes such as decreased skin turgor and slightly decreased nutritional needs is not an indication of ageism. Similarly, safety measures are unlikely to be motivated by ageist beliefs. Assuming that all older adults have cognitively deficits, however, is an indication of ageism.
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 Stress incontinence is caused by pelvic floor muscle weakness or urethral hypermobility. Urge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contraction. Overflow incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system.
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.
A nurse is providing discharge instructions to an elderly client and his daughter. The daughter asks for suggestions to help keep her father healthy. Which of the following could the nurse suggest?
The client should have his eyes examined every year for glaucoma.
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.
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.
Which suggestion would be most appropriate for an older adult experiencing sleep problems. Select all that apply.
avoiding watching television before bed avoiding watching the clock when awake keeping the bedroom cool and quiet Helpful strategies to promote sleep include avoiding technology (such as television) before bed, avoiding exercise for 3 to 4 hours before bedtime, avoiding caffeine (such as tea), sleeping in a cool quiet environment and avoiding watching the clock upon awakening.
A nurse is preparing a presentation for a group of families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease:
doubles every 5 years. According to the Alzheimer's Association, the prevalence of Alzheimer's disease doubles every 5 years beyond age 65.
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
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 being cared for at home has developed a decubitus injury. The nurse would instruct the family caregiver to institute measures to:
relieve sustained pressure. Although incontinence and malnutrition can place a client at risk for skin breakdown, the priority would be to relieve sustained pressure, which is the underlying cause of a pressure injury, also known as a decubitus ulcer. Promoting bowel elimination would have no effect on skin integrity. However, the caregiver should implement measures to prevent fecal incontinence, which could place the client at risk for skin breakdown.
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.
An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for:
suicidal thoughts. 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.
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
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 The nurse would expect a newly hospitalized older adult to take longer to respond and react. It is normal for an older adult to take longer to respond and react, particularly in new or unfamiliar surroundings. Knowing this, the nurse should slow the pace of care and allow older clients extra time to ask questions or complete activities.
