Coursepoint ch. 19
As a follow-up to the introduction of a new medication regimen for an older adult's client, the physician is interpreting the client's recent blood work, paying particular attention to the client's serum creatinine (Cr) levels (normal range 0.6-1.2 mg/100mL) and glomerular filtration rate or GFR (normal value >60 mL/minute). Which of the following lab results would be considered typical of an older adult with impaired renal function? - Cr 1.8; GFR 66 - Cr 2.3; GFR 30 - Cr 0.5; GFR 58 - Cr 1.1; GFR 22
Cr 1.1; GFR 22
Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis? - Serum calcium levels - Dual-energy x-ray absorptiometry (DXA) of the spine and hip - Magnetic resonance imaging (MRI) of the chest cavity and femur - Body mass index (BMI)
DXA of the spine and hip
To help diagnose problems in cognitive function, many nursing facilities utilize the Mini-Mental State Examination (MMSE) tool. Which of the following statements accurately describes this tool? - It contains roughly 75 questions that will help identity those individuals at risk for harming themselves. - It is a brief, objective tool that will assess memory, orientation and attention. - It is primarily used as a diagnostic tool to help differentiate Alzheimer's disease versus dementia. - This tool can be utilized to identify worsening of short-term memory.
it is a brief, objective tool that will assess memory, orientation and attention
the nurse is caring for a client with osteoporosis. Which T score should the nurse expect to find? - less than -3.5 less than -4.5 - less than -2.5 - less than -5.5
less than -2.5
A nurse is assessing an older adult with reports of constipation, for which the client often takes over-the-counter medications. What assessment should the nurse perform to address the etiology of the client's problem? - Signs and symptoms of diverticula - Medication regimen for drugs like anticholinergic agents or calcium - History of hemorrhoids or rectal fissures - History of cesarean birth or other abdominal surgery
medication regimen for drugs like anticholinergic agents or calcium
the nurse is assessing a female client's risk for osteoporosis. Which factor places this client at greatest risk? - menopause. - black race. - male gender. - obesity.
menopause
In considering a definition of aging, a 76-year-old male would be classified into which of the following subgroups? - Middle-old - Young-old - Old-old - Oldest-old
middle-old
Which statement demonstrates and supports the stochastic free radical theory of aging? - The interrelationship between neurons and hormones is what causes cells to age. - Genes are ultimately responsible for harmful effects of aging. - Aging is caused by impaired caloric restrictions. - Mitochondria DNA may become damaged from reactive oxygen species (ROS).
mitochondria DNA may become damaged from reactive oxygen species
An older adult client is admitted for the treatment of pneumonia. The nurse notes the home medications include nasal calcitonin, vitamin D, and calcium chloride. Which disease process is this client likely treating with these medications? - Scleroderma - Osteoarthritis - Rheumatoid arthritis - Osteoporosis
osteoporosis
The nurse is caring for an older adult client at increased risk for fall-related injury. Which additional condition contributes to this risk? - Parathyroid dysfunction - Decrease in brain mass - Osteoporosis - Dietary calcium deficiency
osteoporosis
The first manifestation that a client has osteoporosis is when presenting with which condition? - Bone pain that is not alleviated by rest - A bone fracture - Craving high-calcium foods - Decreased range of motion in the hip and knee joints
a bone fracture
Which best describes metatarsus adductus? - An adducted forefoot that gives the foot a kidney-shaped appearance - An abnormal rotation of the hip - A condition of toeing-out caused by external femoral torsion - A condition involving a congenital dislocation at the hip
an adducted forefoot that gives the foot a kidney-shaped apppearance
A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be: - brisk walking three times per week on a flat surface. - high impact aerobic exercise for 1 hour three times per week. - lawn bowling for 1 hour per week. - running 1 mile per day with good athletic shoes
brisk walking three times per week on a flat surface
Which measures should a public health nurse recommend to middle-aged women to reduce their chances of developing osteoporosis later in life? - Weight control and daily use of low-dose corticosteroids - Genetic testing and range-of-motion exercises - Calcium supplementation and regular weight-bearing activity - Increased fluid intake and use of vitamin D supplements
calcium supplementation and regular weight-bearing activity
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer disease. What intervention will be implemented to slow cognitive decline? - psychotherapy - cholinesterase inhibitors. - lipid-lowering agents. - antioxidant therapy
cholinesterase inhibitors
Gastrointestinal elimination in older adults is often characterized by which common symptom? - Constipation - Diarrhea - Decreased gas production - Increased mucus
constipation
What contributes to impairment in renal function in aging? - Increase in renal mass - Decrease in functioning nephrons - Increase in glomerular filtration rate - Enhancement of the proximal tubule function
decrease in functioning nephrons
Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process? - Decreased elasticity in arterial connective tissue - Increased elasticity in arterial connective tissue - Decreased elasticity in venous connective tissue - Increased elasticity in venous connective tissue
decreased elasticity in arterial connective tissue
A client with Alzheimer disease (AD) is forgetful and has started to lose interest in social activities. Which treatment routine would be beneficial for the client? - Donepezil - Memantine - Vitamin D - High protein diet
donepezil
The nurse is performing a skin assessment for an older adult client. Which age-related finding(s) should the nurse anticipate? (Select all that apply.) - Dry, wrinkled appearance - Rough, raised skin lesions - Clubbing of the fingernails - Varied skin pigmentation - Decreased elasticity
dry, wrinkled appearance, varied skin pigmentation, decreased elasticity
The educator of a geriatric unit is orienting new staff and is teaching strategies on communicating with older adults with impaired hearing. Which teaching point is most appropriate? - "Ensure that the hearing aid is in place, turned on, and properly functioning." - "Avoid complex or abstract ideas when you are talking." - "Increase the volume of your speech as much as possible." - "Choose simple, short words to minimize confusion."
ensure that the hearing aid is in place, turned on, and properly functioning
Disorders that affect cortical bone typically result in: - Fractures of long bones - Impaired collagen synthesis - Infection - Vertebral fractures
fractures of long bones
The nurse is caring an older adult client. The nurse is teaching about immune response. Which statement(s) will the nurse include in the teaching? Select all that apply. - As an older adult client, you are at a higher incidence of herpes zoster. - As an older adult client, you have an increased rate of death if diagnosed with pneumonia. - As an older adult client, you have a decreased rate of hospital-associated infections like MRSA in skilled nursing facilities. - As an older adult client, you have impaired wound healing due to altered immune function. - As an older adult client, you have an overabundant production of subcutaneous fat resulting in your larger body surface, which impedes healing.
higher incidence of herpes zoster, increased rate of death if diagnosed with pneumonia, impaired wound healing due to altered immune function
The nurse is reviewing the laboratory results of an older adult client with a diagnosis of water retention. Which additional condition should the nurse anticipate? - Hyponatremia - Hypokalemia - Hypoalbuminemia - Hypocalcemia
hyponatremia
The nurse is assessing a client with stage 2 Alzheimer disease. Which finding(s) should the nurse anticipate? (Select all that apply.) - Inability to locate everyday objects - Loss of awareness of surroundings and recent experiences - Memory lapses - Occasional loss of memory of spouse's or primary caregiver's name - Forgetfulness of familiar words
inability to locate everyday objects, memory lapses, forgetfulness of familiar words
A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that: - intestinal absorption slows as natural aging occurs. - her parent is consuming a diet high in calcium. - there is an absorption of too much vitamin D. - her parent is not using any sunscreens to help with absorption.
intestinal absorption slows as natural aging occurs
A physiotherapist (PT) at an assisted living facility for older adults is leading an exercise class for the residents. Part of the PT's introductory class is an explanation of the health problems that can be mitigated by physical activity and those which are considered inevitabilities of the aging process. Which of the following phenomena would the PT most justifiably characterize as modifiable? - Reduction in density of the trabecular bone. - Gradual decline in physical reaction time. - Overall reduction in muscle strength. - Decline in height.
overall reduction in muscle strength
A client's family member is reporting changes in their adult parent. Which manifestation(s) indicates to the nurse that the client is experiencing impaired neurologic function? Select all that apply. - ringing in the ears (tinnitus) - prolonged time to complete activities of daily living - slowed reaction time, especially when driving - mild forgetfulness - faster but stiffer gait
prolonged time to complete activities of daily living, slow reaction time, especially when driving, mild forgetfulness
A family has brought an older adult parent to the clinic with concerns of cognitive decline. The nurse notes that which clinical manifestation(s) places this client in stage 3 Alzheimer disease? Select all that apply. - forgetfulness of familiar words - altered memory of where everyday items are located - requires assistance in day-to-day activities - regularly misplaces valuable objects - difficulty with reading retention - withdrawn personality
regularly misplaces valuable objects, difficulty with reading retention
The adult child of a client with end-stage Alzheimer disease asks the nurse if Alzheimer disease can be passed on to him or her. What is the nurse's most accurate response? - "There is no evidence that the disease is genetic." - "Research supports a possible genetic link with an early onset." - "Research supports that late onset is genetic." - "Research supports that the disease is always inherited."
research supports a possible genetic link with an early onset
Which teaching will the nurse provide for parents of a child who has clubfoot, or talipes? - Serial manipulations and casting of the affected extremity - Immediate corrective surgery - Bilateral hip spica cast - Chemotherapy
serial manipulations and casting of the affected extremity
A postmenopausal client questions the nurse about the diagnosis of osteoporosis. Which statement describes the pathology of osteoporosis? - The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown. - Estrogen levels increase with menopause and contribute to bone loss. - Bone loss occurs after multiple infections occur throughout a lifetime. - Osteoporosis can be resolved with increasing calcium intake to strengthen the bones.
the process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown
The spouse of a client diagnosed with Alzheimer disease asks the nurse why the client often neglects to take a shower. The spouse states that the client was always diligent with hygiene in the past; however, over the past few months that has not been the case. What is the nurse's best response? - "The client just does not care anymore." - "The client would be fine without showering." - "The client is experiencing a temporary relapse." - "You should remind the client to shower."
you should remind the client to shower