Chapter 23 The Older Adult

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."

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

Which factor contributes to sleep disturbances in older adults?

Beta-blockers

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 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

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

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

Women over the age of 75

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."

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."

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 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 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.

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."

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

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 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 patient with skin pigmentation caused by exposure to sun over the years

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.

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.

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.

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.

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 Rationale: S—Sleep disorders P—Problems with eating or feeding I—Incontinence C—Confusion E—Evidence of falls S—Skin breakdown

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.

An older adult client is placed on an inpatient unit following a minor stroke after moving in with an adult child recently. The client states to the nurse, I have difficulty finding meaning in life." The nurse suspects that the client is suffering from depression. Which factors may contribute to this client's depression? Select all that apply.

-The depression may have gone undetected since it is an under diagnosed disorder. -The stroke may be a contributing factor. -A recent change in living environment can cause depression.

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%

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 Rationale: Dementia, AD, depression, and delirium may occur and cause cognitive impairment. AD is the most common degenerative neurologic illness and the most common cause of cognitive impairment. It is irreversible, progressing from deficits in memory and thinking skills to an inability to perform even the simplest of tasks. The leading causes of death in adults aged 65 and older are heart disease, cancer, chronic respiratory disease, stroke, AD, and diabetes.

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 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

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.

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

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

Dementia

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

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

A nurse is making a home visit to an older adult with multiple chronic health problems. The client is alert and oriented and his cognition is intact. While talking with the client, he reveals that he thinks his son is stealing his social security checks to buy his beer and eat out all the time. The nurse interprets this statement as possibly suggesting which type of elder abuse?

Exploitation

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.

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

A nurse is working with an older adult population at a local community senior center. Based on information from the Association of Aging, the nurse would anticipate needing to address which condition as most common?

Hypertension

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 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 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.

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

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.

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

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 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 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

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 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 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

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

loss of physiologic reserve of the organ systems.

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