FN - Unit 2 - Chapter 24: Middle and Older Adulthood

An older adult is prescribed an antipsychotic. The nurse understands that this medication is used to treat which manifestation? Select all that apply. Delusions Hallucinations Feelings of hopelessness Suicidal ideation Excessive anxiety

Delusions Hallucinations Antipsychotic medications typically are used to treat adverse delusions (fixed beliefs that contradict reality) and hallucinations (false perceptions such as sounds, smells, visions that have no relation to reality). They are not used to treat feelings of hopelessness, suicidal ideation or excessive anxiety.

An older adult 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? Respite care Naturally occurring retirement communities (NORCs) Extended-care facility Accessory apartment

Extended-care facility If the older adult is cognitively impaired, family caregivers face the need for daily care giving, such as that which is provided in an extended-care facility. Respite care is temporary housing and NORCs enable the client to remain at home. Accessory apartments are separate apartments constructed, in part, out of an existing house and do not have any health care services.

The nurse is assigned to care for a client age 87 years admitted to the medical unit for congestive heart failure. It is the fourth hospital day, and the response to treatment has been good. The client is no longer short of breath and the lung sounds are clearing. There is still a diet restriction of decreased sodium and fluids are limited to no more than 1000 mL per day. The nurse is preparing the client and family for discharge. The nurse's discharge education, in order to promote the older client's health, will include which instructions? Select all that apply. Gradually increase activities as tolerated. Do not use the salt shaker at meals. Increased stress may interfere with recovery. Take several naps during the day.

Gradually increase activities as tolerated. Do not use the salt shaker at meals. Increased stress may interfere with recovery. Promoting health for older adults includes ensuring adequate nutrition (e.g., low-fat diet, other diet modifications); balancing calories and activities; planning exercise as a daily activity; and educating the client that illness is a physical and emotional stress and increases the risk for complications. Taking naps will interfere with sleep at night.

A nurse is assessing a 55-year-old female client. What is a normal physical change in the middle adult? Select all that apply. Skin moisture increases. Hormone production increases. Hearing acuity diminishes. Cognitive ability diminishes. Cardiac output begins to decrease. There is a loss of calcium from bones.

Hearing acuity diminishes. Cardiac output begins to decrease. There is a loss of calcium from bones. Normal physical changes that occur in the female middle adult include: hearing acuity diminishes, cardiac output begins to decrease, and there is a loss of calcium from bones. Skin becomes more dry, hormone production decreases, and cognitive ability does not diminish.

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. Nutrition contributes to immune system function in older adults. Alcoholism diminishes immune system function in older adults. Pneumonia is caused by polypharmacy in the older adult

Humoral immunity declines. Older adults are more susceptible to pneumonia following respiratory infections. As people age, their immune system becomes less efficient. Their humoral immunity declines due to diminished T-cell function, and older adults have lower antibody response following respiratory infections to fight off pneumonia. Nutrition does not contribute to immune system function in older adults. Alcoholism may contribute to depression but not diminished immune function. Polypharmacy can lead to many situations with drug interactions but is not the cause of community acquired pneumonia.

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 Disengagement theory Activity theory Life review 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.

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 Presbyopia occurs Menopause occurs Agility gradually decreases

Lower extremity pulses are weak Normal physiologic changes of the middle-aged adult do not include peripheral pulses becoming weak and not always palpable. The other options can be seen in a middle-aged adult.

Which group of individuals in the older adult population is most likely to be widowed? Women under the age of 65 Men under the age of 70 Men over the age of 75 Women over the age of 75

Women over the age of 75 Loss and grief are a significant factor in the older adult population. In 2008, almost half of women (42%) were widowed by age 65, compared with 14% of men. Of women 75 years or older, only 28.9% lived with a spouse (AOA, 2009).

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 minimal risk of adverse effects rare occurrences of confusion need for follow-up laboratory tests

greatest effectiveness with short term use Sleep medications may be used, but these drugs are most effective when limited to short-term use (7 to 14 days); otherwise, the medications may actually interfere with sleep and cause other adverse outcomes such as falls, confusion, and constipation. The risks for adverse effects depend on the drug prescribed. There is no need for follow up laboratory tests.

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 Dementia Disorientation Depression

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.

What term is used to describe various disorders that progressively affect cognitive function? Dementia Ageism Reminiscence Delirium

Dementia 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.

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? Introduce the family to the hospital chaplain for religious counseling. Coordinate a family meeting to make sure everyone has the same information. Explain that delirium is a state of confused thinking and usually lasts only a short time. Refer the family to the health care provider for support.

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 has decided to specialize in the care of the aging individuals in both illness and health. What is the term for this nursing specialty? Gerontologic nursing Nephrology nursing Neurologic nursing Genetic nursing

Gerontologic nursing Gerontologic nursing combines the basic knowledge and skills of nursing with a specialized knowledge of aging in both illness and health. Nephrology nursing would be involved with focusing on kidney functioning. Neurologic nursing would involve clients with problems and issues related to the nervous system including the brain and spinal cord. Genetic nursing would relate to nursing focused on genetics, genetic testing, and genetic disorders.

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? Have a colonoscopy every 10 years Obtain the zoster vaccine Perform self-examination of the skin every month Have a physical examination every 3 years

Perform self-examination of the skin every month Guidelines for health-related screenings, examinations and immunizations for the adult include self-examination of the skin every month; beginning at age 50, colonoscopy every 3-5 years; physical examination every year from age 40; the zoster vaccine is recommended for adults 60 years and older.

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. Stage 1 sleep increases in the older adult. Deep sleep declines in the older adult. Chronic cardiovascular or respiratory illness can interfere with sleep.

Sleep medications are usually the first choice in treating sleep disturbance. 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.

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. The client states that his urine stream is less strong than in the past. The client claims to hear high-pitched sounds less clearly than earlier in life. The client's gait is slow and his posture appears stooped.

The client is oriented to person and place but is unsure of the month. Age-related physiologic changes include a weakening of bladder emptying, presbycusis, and a slow gait that may be accompanied by stooped posture. Disorientation to time, however, should always prompt the nurse to perform further assessment and should never be considered a normal accompaniment to the aging process.

The hospice nurse is visiting the spouse of a client who died 4 weeks prior. Which behavior by the spouse concerns the nurse? Cries when discussing the client's death Leaves the client's clothes untouched in the closet Voices the inability to leave the home without the client Keeps pictures of the client around at all times

Voices the inability to leave the home without the client Grieving responses vary among all people. There is no "right or wrong" way to grieve; however, maladaptive behaviors, such as not leaving the home because the client is deceased, may threaten the health of the spouse. The nurse would investigate this statement further to assure the client is eating and has support from loved ones or friends. Crying when discussing the client's death is normal grieving. Leaving the client's clothes untouched is normal grieving for 4 weeks after the death. Keeping the picture of the client around at all times is normal grieving in this stage.

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. hearing loss medication use diminished strength environmental hazards changes in bowel function

medication use diminished strength environmental hazards Multiple factors place the older adult at risk for falls, including the use of medications affecting balance, thinking, memory, and elimination; impaired vision; environmental hazards (e.g., slippery floors, throw rugs, poor lighting); decreased strength; loss of bone mass; and neurological and musculoskeletal problems. Hearing loss and changes in bowel function are not associated with an increased risk for falling.

An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for: poor cognitive performance. sleep problems. lack of initiative. suicidal thoughts.

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? talk rapidly but be confused withdraw from strangers interrupt with frequent questions take longer to respond and react

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.

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. "Can you tell me what your sleep patterns are?" "Have you had any changes in weight recently such as a gain or loss?" "Have you been seeing things that no one else seems to see?" "What foods do you like to eat?" "Have you lost interest in things you previously found pleasurable?"

"Can you tell me what your sleep patterns are?" "Have you had any changes in weight recently such as a gain or loss?" "Have you lost interest in things you previously found pleasurable?" 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 try not to be too active once I've eaten dinner." "I find myself napping on and off throughout the day." "I go to bed around 10:30 pm every night." "I don't drink coffee or alcohol."

"I find myself napping on and off throughout the day." The client's statement about napping throughout the day will need to be addressed by the nurse because this can interfere with the client's ability to sleep at night. Avoiding activity after dinner, having a routine bedtime, and avoiding caffeine and alcohol are healthy sleep habits.

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 should do some mild exercises about 2 hours before bedtime." "I need to try and go to bed and get up at the same time each night." "I should continue to take my sleep medication for as long as I need to." "I should avoid coffee, but tea is okay to drink before bed."

"I need to try and go to bed and get up at the same time each night." Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains).

The geriatric nurse is evaluating a new nurse's understanding of the theories of aging. Which statement shows the new nurse understands the theories? "In the wear and tear theory, cells become exhausted from continual energy depletion." "In the cross-linkage theory, molecules with separated high-energy electrons can have adverse effects on adjacent molecules, especially lipids." "Free radical theory is a chemical reaction that produces damage to the DNA and cell death." "Immunosenescence is thought to be responsible for heart disease as adults age."

"In the wear and tear theory, cells become exhausted from continual energy depletion." The wear-and-tear theory holds that organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion. Cross-linkage is a chemical reaction that produces damage to the DNA and cell death. Free radical theory holds that free radicals formed during cellular metabolism are molecules with separated high-energy electrons that can have adverse effects on adjacent molecules, especially lipids. Age-associated changes in the immune system, known as immunosenescence, are thought to be responsible for the increase in infections such as pneumonia and septicemia, immune disorders, and cancer as adults age.

A nurse is teaching an older adult 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? "Dementia is an acute process and develops suddenly." "Sundowning is a common problem of dementia." "Delirium progressively affects cognitive function and is a chronic process." "Alzheimer's disease (AD) is a reversible neurologic illness."

"Sundowning is a common problem of dementia." A common problem in clients 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 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? Turn her every hour when in bed Ask her to call the nurse when she feels the need for elimination Insert an indwelling catheter to prevent urine from causing skin breakdown Assist her to the toilet every 2 hours and after meals

Assist her to the toilet every 2 hours and after meals Implementing a toileting schedule will help prevent skin breakdown. Turning will not address the incontinence issue. Since the resident has poor cognition, asking her to notify the nurse for elimination needs is unrealistic. An indwelling catheter may increase her risk for infection and will not address the fecal incontinence.

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. American Indian/Alaska Natives have an infant mortality rate 75% higher than that of Whites. Black adults are diagnosed with diabetes and die from diabetes almost three times as often as White adults. 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.

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. Several examples reflect correct information about particular ethnic or racial groups. 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 is Asians in America that Whites. Several examples were incorrect. American Indian/Alaska Natives have an infant mortality rate 60%, not 75%, higher than that of Whites. Black adults in America are diagnosed with diabetes and die from diabetes almost two times, not three times, as often as White adults.

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. Systolic blood pressure decreases with age. Resting heart rate decreases with age. The cardiac output is increased with age.

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.

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. Avoid identifying yourself each time. Call the client by name. Speak in a loud tone of voice. Use short, simple words when conversing with the client. Ask the client "Do you remember me?" when interacting

Call the client by name. Use short, simple words when conversing with the client. When communicating with a client who is cognitively impaired, the nurse should identify himself with every interaction, call the client by name, use short, simple words and sentences and speak slowly, softly, and calmly. The nurse should also turn questions into answers; for example, rather than asking the client if he has to go to the bathroom, say, the bathroom is right here.

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. Loss of fatty tissue Low-pitched sounds are more difficult. Visual acuity changes with myopia.

Cardiac output decreases. Middle age changes include the following: redistribution of fatty tissue around the middle and abdomen; drier skin; wrinkles develop; hair grays and men may experience baldness; cardiac output decreases; near-vision diminishes; presbyopia; hearing diminishes, especially high-pitched sounds; hormone levels decrease; calcium loss from bone occurs; decrease in muscle strength.

A nurse is making a home visit to an older adult with multiple chronic health problems. The client is alert and oriented and cognition is intact. While talking with the client, the client reveals a belief that the adult child is stealing the client's social security checks to buy beer and eat out all the time. What action should the nurse first do regarding the possible elder abuse to keep the client safe? Immediately report the abuse to the state authorities. Educate the adult child on how to recognize and prevent elder abuse. Complete an elder abuse assessment by using an elder abuse screening tool. Educate the client on how to recognize and prevent elder abuse.

Complete an elder abuse assessment by using an elder abuse screening tool. The client could be a victim of exploitation which involves illegally taking or misusing the funds, property, or assets of a vulnerable older adult. There are many elder abuse assessment tools available for healthcare providers. Many states require the nurse to report suspected elder abuse; however, the nurse should first assess the client using an elder abuse screening tool. More information should be gathered before reporting the abuse to authorities in order accurately report the facts of the case. Educating the adult child more than likely would not prevent the abuse from happening. Educating the client on elder abuse may help the client to understand that they may be the victim of abuse, but it won't keep them safe.

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 Generalized anxiety disorder Realistic caution Bipolar disorder

Depression The nurse should assess the client and determine if depression is occurring first. Depression can be treated and the client's condition improved. If depression is not the issue, then the nurse could further assess and determine if there is another issue which should be addressed.

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. Depression is considered a normal part of aging. The stigma associated with depression is less for older adults. Suicide is the most serious consequence of depression.

Depression is often misdiagnosed. Symptoms often mimic those of other chronic comorbidities of the older adult. Suicide is the most serious consequence of depression. Mood disorders (especially depression) are often unrecognized or misdiagnosed in older adults partly due to the false belief that depression is a natural reaction to illness, advanced age, or life changes that occur with age. Therefore, depression is not viewed as something that needs to be treated in the older adult. Furthermore, symptoms of depression may include poor cognitive performance, sleep problems, and lack of initiative ? symptoms commonly seen in people with multiple chronic comorbidities (such as diabetes or heart failure) or in clients with dementia or delirium, causing it to be unrecognized. Although depression is not a normal part of aging, older adults are at an increased risk of experiencing depression due to chronic illness and other age-related changes. The older adult population is also less likely to report symptoms due to the stigma attached. Suicide is the most serious consequence of depression.

The nurse understands that when caring for the older adult it is important to assist in maintaining independence and self-esteem. Assisting the client to adjust to a walker or wheelchair is an example of supporting which of Erikson's developmental tasks of the older adult? Adaptation to age and preservation of self Ego integrity and coping with reality of limitations Functional adaptation and self-awareness Prevention of injury and safety in navigation

Ego integrity and coping with reality of limitations Age does affect the older adult due to many different physiological changes, as evidenced by a decrease of cardiac output, peripheral circulation, oxygenation of blood, decreased ability to control temperature, and a slower heart rate. Ego integrity is the task of the older adult, according to Erikson, including "wholeness," emotional integration, and acceptance of physical decline. The others are not developmental tasks described by Erikson.

A nurse is preparing to medicate an older adult client with an opioid analgesic. Which information will the nurse obtain first to decide about administering the medication? Observing client behavior to determine if coincides with report of pain Taking the clients vital signs to determine if indicative of pain Determining if the client is able to communicate pain verbally or nonverbally Obtaining family feedback about client's pain level

Determining if the client is able to communicate pain verbally or nonverbally The nurse should ascertain the level and intensity of the client's pain. The family is not able to give adequate information about the client's pain. Taking the client's vital signs can be of value as a baseline. A client may share indication of pain other than verbally, such as a grimace or moaning. Each client may exhibit different behaviors when in pain. This is not a reliable indicator as to a client's pain level.

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? Counseling a client who complains of being depressed Providing entertainment for a client on bedrest Arranging for social services to assist with meals for a homebound client Encouraging a client to have regular checkups

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? Distracting the client Praising the client Encouraging life review Promoting independent living

Encouraging life review The intervention that would best foster older clients' ego integrity would be encouraging life review. 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. In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Integrity vs. despair and disgust would not be fostered by distracting the client, praising the client, or promoting independent living.

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. An older adult experiences numerous factors that increase the risk for falls. Older adults are faced with challenges related to the fear of falling and striving for independence. Medications in the older adult play a major contributing role to the risk for falling.

Falls are the leading cause of death due to injury in individuals who are over the age of 75 years. For people over the age of 65 years, falls are the leading cause of injury leading to death, with hip fractures resulting in significant morbidity and mortality. Numerous factors place the older adult at risk for falls, including a history of falls, fear of falling, cognitive and mood impairments, dizziness, functional impairments, and environmental hazards. Older adults are faced with dealing with the fear of falling and striving for independence. Medications often play a major role in contributing to falls and other complications in the older adult.

A nurse is caring for an older adult client who has been confined to bed for several weeks following a fall. The client has been exhibiting symptoms of sundowner's syndrome. Which of the following are characteristics of sundowner's syndrome? Awakening more frequently Requiring longer time to fall asleep Napping during the daytime Feeling agitated and wakeful at night

Feeling agitated and wakeful at night Clients with sundowner's syndrome feel agitated and wakeful at night. Older adult clients who are institutionalized or cognitively impaired may develop sundowner's syndrome. Awakening more frequently, requiring longer time to fall asleep, or napping during the daytime are a natural part of aging.

The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what? Initiative versus guilt Ego-integrity versus despair Generativity versus stagnation Goal attainment versus crisis

Generativity versus stagnation 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.

The nurse is monitoring T cell activity following a hematopoietic stem cell transplant in an older adult. Which information will the nurse share with the client and family regarding T cell significance? T cells are monitored to determine the aggressiveness of cancer and are used as a guide to select appropriate chemotherapy. Immunity is suppressed following chemotherapy, and T cell counts provide information on susceptibility to infection. T cell counts are used to identify the presence of infection for clients following hemopoietic stem cell transplant. T cells or "thrombocytes" are monitored to determine likelihood of thrombus formation.

Immunity is suppressed following chemotherapy, and T cell counts provide information on susceptibility to infection. T cells fight infection. As such, lower T cell counts from chemotherapy place the client at higher risk for infection. T cells are not monitored for aggressiveness of cancers, nor do they influence selection of chemotherapeutic agents. T cells are not monitored to determine presence of infection rather it provides insight regarding susceptibility to infection. T cells and thrombocytes are two completely different cell types.

The nurse is planning an educational event for a group of senior citizens on the topic of the normal signs of aging. Which topic(s) should the nurse include about healthy activities a person can engage in to prevent the problems associated with aging? Select all that apply. Taking a variety of daily vitamins and supplements Initiating good lifestyle habits including diet and exercise Following a routine disease prevention and treatment program Engaging in activities only aerobic in nature to prevent injury Maintaining friendships and social activities

Initiating good lifestyle habits including diet and exercise Following a routine disease prevention and treatment program Maintaining friendships and social activities Physiologic changes and an increased incidence of chronic illnesses place older adults at greater risk for declines in health and quality of life. Health promotion strategies (good lifestyle habits) and health maintenance (disease prevention and treatment) afford even the oldest adult an advantage in maintaining optimal health. Exercise, not necessarily vigorous aerobic, is an example of a good lifestyle habit. Taking all medications as prescribed is an example of health maintenance. Vitamins and supplements should only be taken under the supervision of a health care provider. Maintaining friends and social activities have been noted as improving overall health in older adults as it prevents loneliness and "hibernation" type activities.

The nurse is reminiscing with a 72-year-old client with early onset dementia while providing care in a long-term care facility. How does the nurse implement this form of therapy to maximize the therapeutic value? Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship. Ask questions about the client's childhood and any unresolved relationship issues that may be preventing the client's peace and acceptance of the aging process. Ask family members to participate in activities that help the client remember important aspects of life and health so he/she can move through the final stages of aging. Encourage the client to talk about special life experiences so discussions regarding death and dying can be easier and can prepare the client for declining health.

Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship. Reminiscence is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Listening and asking questions also provides a sense of companionship to clients as they often experience loneliness during dementia even though they may have family members that visit. , nor does it support the client's acceptance of declining health status.

A nurse is assessing middle-age adults living in a retirement community. What behavior would the nurse typically see in the middle-age adult? Believes in establishment of self but fears being pulled back into the family Usually substitutes new roles for old roles and perhaps continues formal roles in a new context Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community Looks forward but also looks back and begins to reflect on his or her life

Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community Middle-age adults would be looking inward, accepting the life span as having definite boundaries, and having special interest in spouse, friends, and community. The other options are behaviors of the older adult.

A home care nurse is visiting one of her older adult clients. Which of the following does the nurse do to screen for chronic illnesses common to older adults? Select all that apply. Monitor blood pressure Perform blood glucose monitoring Assess joint mobility and presence of pain Assess skin turgor Assess visual acuity

Monitor blood pressure Perform blood glucose monitoring Assess joint mobility and presence of pain In the older adult, the most commonly encountered chronic disorders are hypertension (monitor blood pressure), arthritis (assess joint mobility and presence of pain), heart disease, cancer, diabetes (perform blood glucose monitoring), and sinusitis. Assessing skin turgor and visual acuity, which often decrease in the older adult, does not provide information about these chronic conditions.

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? Blacks Non-Hispanic Whites Hispanics Asians

Non-Hispanic Whites In 2012, 21% of people 65 and over were members of racial or ethnic minority populations. Racial and ethnic minority groups have increased from 6.1 million in 2002 (17% of the older population) to 8.9 million in 2012 (21% of the older population) and are projected to increase to 20.2 million in 2030 (28%% of the older population). Between 2012 and 2030, the white non-Hispanic population 65 years or older is projected to increase by 54%, compared with 123.5% for older racial and ethnic minorities, including Hispanics (155%); Blacks (104%); American Indian and Native Alaskans (116%); and Asians (119%).

A public health nurse is participating in a health fair that is being held at a local community center. The nurse should encourage adult participants to completely eliminate which of the following from their diet and lifestyle? Smoking Alcohol Salt Cholesterol

Smoking Alcohol, salt, and cholesterol all have the potential to cause harm when used in excess. However, moderate and conscientious intake of each is not unhealthy, and complete elimination of cholesterol or salt from the diet would in fact be harmful. Smoking, however, is never a benign activity and even "moderate" smoking should be discontinued.

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 men are more likely to be widowed. 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. The average income for older adults has decreased over the past years.

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. Older men were much more likely to be married than older women - 71% of men and 45% of women. Widows accounted for 36% of all older women in 2013. There were over three times as many widows (8.7 million) as widowers (2.3 million). The proportion living with their spouse decreased with age, especially for women. Most older adults find that they are satisfied with their lives and enjoying retirement and old age more than they had anticipated. The median income of older adults in 2012 had increased from 2008 by $27,612 for males and $16,040 for females.

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? Old age begins at age 65. Personality is not changed by chronologic aging. Most older adults are ill and institutionalized. Intelligence declines with age.

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.

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? Use a matter-of-fact attitude and gently help him back to his room. Remind him that he must not get up unassisted and should stay in his room at night. Remind him of where he is and assess why he is having difficulty sleeping. Allow him to sleep in the recliner in the day-room, so he will not disturb other clients.

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.

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? Call the police and tell them to swear a warrant for the arrest of the sister. Report the incident to social service informing them the client has no food or heat. Tell the client to talk with the sister and have her replace the money she has stolen. Take the client to the local hospital Emergency Department.

Report the incident to social service informing them the client has no food or heat. The client is apparently a victim of financial abuse and is being left without resources in order to live comfortably and to have basic needs cared for. The nurse should not confront the sister or have the client confront her due to the potential for violence. The incident must be reported to social service to have them involved with obtaining immediate resources for the client. Taking the client to the Emergency department would be against regulations for home health nurses and the client is not in need of immediate medical attention.

An 85-year-old client's adult child calls the nurse and states their parent is recently having periods of confusion, is unable to dress themelf, and is having periods of incontinence. Which action should the nurse do first? Schedule an appointment for a physical examination. Make arrangements for the client to move to an extended-care facility. Teach the adult child how to use reminiscence as a therapy. Perform a SPICES assessment.

Schedule an appointment for a physical examination. Drug interactions, circulatory or metabolic problems, nutritional deficiencies, or a worsening illness are likely causes for confusion and changes in function, thus a physical examination is indicated for this client. Moving to an extended-care facility is premature until physical causes have been examined. Reminiscence therapy, a way for older adults to facilitate adaptation by reliving past experiences, is used for psychosocial development. A SPICES (sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown) assessment is used to identify issues that can lead to negative outcomes in an older adult client. Although it may be useful in this client, the priority is finding the cause for the physical changes.

The nurse is caring for multiple older adults in an assisted care facility. What information about this population should the nurse consider when caring for clients? Select all that apply. Some clients with dementia may experience sundowning syndrome and safety is a priority. Clients with delirium experience a permanent state of confusion. Symptoms of depression many clients go undiagnosed and nurses should observe closely. All older adults experience delirium when hospitalized. Older adults often use multiple medications and nurse should monitor for risks. Older adults limit their activities because of fear of falling that might result in serious health consequences.

Some clients with dementia may experience sundowning syndrome and safety is a priority. Symptoms of depression many clients go undiagnosed and nurses should observe closely. Older adults often use multiple medications and nurse should monitor for risks. Older adults limit their activities because of fear of falling that might result in serious health consequences. 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. Polypharmacy is common among older adults and requires careful monitoring to minimize the risk for adverse effects, toxicities, and drug-drug interactions. Two statements are untrue. Delirium is not a permanent state of confusion occurring in older adults. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.

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? Implementing falls prevention measures in a setting where older adults receive care Providing slightly smaller servings of food for clients who are older adults Speaking to older adults with the presumption that they have mild cognitive deficits Assessing the skin turgor of an older adult differently than that of a younger adult

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 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. Older men often are at risk for suicide All older adults go through a period of depression

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. Depression is often underdiagnosed in the older adult. Clients suffering from multiple health issues are more likely to report depression than their healthier counterparts. If the client has recently changed housing, this will also put a client at risk for depression.

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? Life expectancy has increased for men but not for women. The group experiencing the largest growth is those 85 years of age and older. The number of older adults has begun to plateau since the year 2000. The older adult population appears to be younger than in the past.

The group experiencing the largest growth is those 85 years of age and older. The older population itself is older than it has been in the past. In 2012, the 65-74 age range was more than 10 times larger than in 1900; however, in contrast, the 75-84 age group was 17 times larger, and those age 85 years or older was 48 times larger. Life expectancy has increased for both men and women. Worldwide, the number of older adults has grown exponentially. Since 1900, the percentage of individuals 65 years or older has tripled, and the number has increased over 13 times. The older adult population itself is older than it has been in the past.

When providing nursing care to older adults, it is most important to provide comfort due to which of the following changes? Dementia Isolation Thermoregulation Sexuality

Thermoregulation The body can adapt to environmental temperatures within broad limits, but age and health status greatly affect this capacity. Thus, in the provision of nursing care that focuses on comfort, the nurse must be aware of changes in thermoregulation.

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. exploitation. neglect. emotional abuse.

abandonment. The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion or a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult.

When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply. enhanced immune function decline in humoral immunity lowered antibody responses inadequate nutrition maintenance of T-cell function

decline in humoral immunity lowered antibody responses inadequate nutrition As people age, their immune systems become less efficient. Humoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause influenza and pneumonia (Frasca, et al, 2010). Inadequate nutrition and chronic illnesses adversely affect the immune system and the ability to ward off infection. Without proper nutrients, basic body functions lack the necessary vitamins, minerals, and food substances (proteins, carbohydrates, and fats) to maintain optimal functioning.

The nurse is caring for an older adult client on the medical unit admitted for diagnostic testing. The client is alert and oriented and lives independently. The client was wearing glasses upon admission. Which nursing intervention will be most effective in the prevention of falls for this client? using a gait belt each time the client ambulates ensuring the client's glasses are close by the bed placing a bed alarm on the bed moving the client to a room close to the nurse's station

ensuring the client's glasses are close by the bed This client does not require aggressive fall prevention measures since the client lives independently, is only having diagnostic testing, and is alert and oriented. Keeping the client's glasses close by will ensure the use of sensory appliances necessary to prevent 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: hospice nursing. geriatrics. long-term care. gerontologic nursing.

gerontologic nursing. Gerontologic nursing combines the knowledge and skills of nursing with specialized focus on the aging in both health and illness. Hospice is end-of-life care, long-term care is a type of care facility, and geriatrics is a branch of medicine.

A 79-year-old client became a widow earlier this year and now resides alone in the house that they and their spouse shared for 30 years. The client's children have encouraged the client to move, but the client expresses a desire to remain in their home, despite some slight mobility challenges. The nurse who provides occasional home health care for the client should first propose which intervention? home modification assisted living long-term care facility homesharing

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 the client's wishes. Home modification may allow the client to maximize independence and maintain their current living situation in spite of some mobility challenges.

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 residents with a history of frequent hospital admissions white females residents with diabetes

residents 85 years or older Studies indicate that an estimated 80% of nursing home residents have substantial, often unrecognized, and undertreated pain (National Pain Foundation, 2010). Older adults least likely to receive analgesics include those 85 years or older, those of a minority race, and those with low cognitive performance.

In a report, the night nurse tells the incoming nurse that one client with dementia. Which nursing concern will the nurse identify to address the client's sundowning syndrome? sleep deprivation social isolation grieving noncompliance

sleep deprivation A common problem in clients with dementia is sundowning syndrome, in which the client habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing concern of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are concern that could be related to a client with dementia but are not related to sundowning syndrome.