Gerontological Exam 2
Significant weight loss
5% in 1 month OR 7.5% in 3 months OR 10% in 6 months -> Assessment is priority (determine cause)
The nurse is most concerned by observing when assisting with an older client's bath:
A slightly raised multicolor lesion with an asymmetrical, irregular border -> A slightly raised multicolor lesion with an asymmetrical irregular border is characteristic of melanoma that accounts for less than 5% of skin cancer cases, but it causes most skin cancer deaths (priority/MOST concerned) -> A firm, irregularly-shaped, pink-colored nodule or persistent red lesion is characteristic of squamous cell carcinoma -> A pearly papule with prominent blood vessels is a characteristic of a basal cell carcinoma. -> A tender, rough, scaly, sandpaper-like patch is a characteristic of actinic keratoses (a precancerous lesion)
Which of the following nursing actions would help minimize the psychosocial impact of bladder and/or bowel incontinence for individuals experiencing incontinence prior to going to a group dining room?
Assess for soiled clothing and change, if necessary. -> Deviations from normal bowel and bladder toileting can lead to chastisement, ostracism, and social withdrawal. -> Providing peri-care and clean underclothing is necessary only if incontinency has occurred ->Asking to toilet the client is not necessarily an effective intervention when the client is consistently incontinent
A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching?
Avoid foods high in purine -> A person who is having an acute attack of gout should: -avoid foods that are high in purine, -take in 2 L of fluid daily, -avoid alcohol, -only have 4-6 ounces of foods high in protein daily.
An older adult with suspected Parkinson's Disease has a "challenge test" performed in order to confirm the diagnosis. The nurse understands that a "challenge test" will demonstrate which of the following?
Dramatic improvement of PD symptoms after administration of levodopa
The partner of a client comments, "Our sex life will certainly suffer now that he's had a heart attack." Which statement is the basis for the nurse's response?
People with heart disease reduce their sexual activity out of fear of their condition. -> Changes might be needed in order to accommodate the illness, but curtailing sexual relations is not necessary. -> The energy expended during sex is not equivalent to briskly climbing six flights of stairs. -> And while the couple may benefit from attending a support group, that fact does not address the immediate situation.
An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which of the following?
Presbycusis -> Presbycusis is a type of sensorineural hearing loss -> It is slow and progressive and often ignored by older adults and considered normal aging -> Symptoms include difficulty filtering background noise and understanding women and children's voices -> Individuals often accuse people of mumbling -> Often, it is recognized by others first, before the affected person notices it. -> Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. -> Tinnitus is a perception of sound in one or both ears where no external sound is present
The nurse is caring for an older client who experienced a hip replacement surgery 10 hours ago. Which intervention will help minimize this client's risk of developing delirium?
Requesting that staff offer fluids each time they interact with the client -> Encouraging fluid intake will help prevent dehydration, which is a major contributor to the development of delirium. -> Avoid use of sleeping medications—use music, warm milk, or noncaffeinated herbal tea to alleviate discomfort and encourage sleep. -> Avoid excessive bed rest; institute early mobilization as appropriate. -> It is appropriate to have family and visitors available to the client, within reason, since doing so will help stimulate the client cognitively.
When an older adult reports experiencing several different stressors over the last 6 months, the nurse demonstrates an understanding of the physiological effects of stress on the body by:
screening the client for abnormally high serum glucose levels -> The production of proinflammatory cytokines influencing these and other conditions can be directly stimulated by negative emotions and stressful experiences.
An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the:
slower ability of the pupil to adjust to changes in lighting -> A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. -> Arcus senilis does not affect vision -> The cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting
Health literacy is defined as:
the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. -> Health literacy involves more than basic reading and writing skills. -> It involves the ability to obtain, process, and understand health information in order to make health care decisions.
A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse's response is:
the exact etiology of glaucoma is variable and often unknown -> When the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. -> Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. -> Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina = floaters.
An older man tells a nurse, "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on the knowledge that:
the lens of the eye loses elasticity causing a loss of focus for near objects. -> Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye.
When assessing an older client for indications of depression, the nurse bases the intervention on the knowledge that:
the older client's symptoms may be atypical for the disorder -> Somatic complaints are often the presenting symptoms of mental health disorders, such as depression, making diagnosis difficult -> Depression is a common disorder among this population but knowing that does not aid in identifying the clients who are depressed
A nurse administers hypodermoclysis (HDC) to an older nursing home resident. The purpose of hypodermoclysis is:
to rehydrate an individual with mild to moderate dehydration -> HDC is an infusion of isotonic fluids into the subcutaneous space -> It is an alternative to IV administration for individuals with mild to moderate dehydration -> It CANNOT be used in individuals with severe dehydration or for any situation requiring more than 3 L over 24 hours
In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets:
white men -> White men older than age 85 have the highest rate of suicide in the United States; they commit suicide at approximately four times the national rate
A nurse caring for an older hospitalized woman is concerned about promoting functional status. Which of the following interventions should the nurse include in this patient's plan of care?
a. Conduct a baseline functional status assessment of the patient b. Request a physical therapy referral d. Progressive mobility interventions e. Encouraging the patient to feed herself
Which of the following are age-related changes that affect hydration status?
a. Decrease in thirst sensation b. Decrease in total body water c. Decrease in ability of kidneys to maximally concentrate urine -> While there is a decrease in bone marrow mass, this does not impact hydration status. ->Bladder capacity decreases; however, this does not directly impact hydration status.
A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase?
a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid e. Hearing annoying loud noises -> most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.
A nurse is caring for an older adult with xerosis. Which of the following interventions should the nurse include in the patient's plan of care?
a. Encourage adequate fluid intake c. Maintain a humid environment d. Apply water-laden emulsions to skin immediately after bathing -> Xerosis is extremely dry, itchy skin. -> Long duration baths or showers should be avoided, and daily bathing may not be needed. -> An environment of 60% humidity is recommended. -> Deodorant soaps should be avoided except in the axilla and groin.
An older adult complains of xerostomia. Which of the following interventions should the nurse implement for this patient?
a. Encourage the patient to brush and floss teeth regularly. b. Encourage the patient to have regular dental screenings. d. Encourage adequate intake of water. e. Provide saliva substitutes. -> Antiseptic mouthwashes usually contain alcohol, which can further dry the mouth. -> Avoid alcohol and caffeine
A nurse is assisting an older adult to cope with the loss of a spouse. The nurse encourages the person to use an emotion-focused coping strategy. Which of the following actions should the nurse take?
a. Encourage the person to cry if they feel like it b. Teach the person relaxation breathing exercises. e. Suggest that the person attend a yoga class. -> Expressing emotion, relaxation exercises, and exercise are all part of an emotion-focused coping strategy -> Developing an action plan is part of a problem-focused coping strategy. -> Reaching out to clergy is part of a religious-focused coping strategy.
An older patient is diagnosed with RLS. Which of the following nonpharmacologic interventions should the nurse include in the plan of care?
a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities. b. Avoid caffeine, alcohol, and tobacco. d. Relaxation techniques may be helpful. -> Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of caffeine, alcohol, and tobacco -> The use of diphenhydramine (Benadryl) as a sleeping medication for older adults is not appropriate. There is also no evidence that it will decrease RLS.
An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus?
a. Exposure to loud noises c. Cerumen buildup d. Side effects of medications -> Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. -> Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis -> Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.
An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient?
a. Go to bed only when sleepy. b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities. d. Do not watch television or work in bed. -> Engaging in exercise immediately before sleep will not assist the person in falling asleep, and use of the computer is also discouraged as it can disturb sleep. -> 3 S's for bed use
Which of the following nursing interventions should be implemented to prevent dehydration in hospitalized older adults?
a. Implementing intake and output recording for any patients with fever, diarrhea, vomiting, or an infection b. Limiting duration of NPO requirements for diagnostic tests and procedures e. Making sure that hospitalized patients have easy access to fluids -> It is not appropriate to administer IV fluids to all hospitalized older adults. IV fluids are administered when there is a clinical indication. -> It is not appropriate to limit the use of diuretics. Diuretics are an important treatment for many older patients. -> Hydration management involves acute and ongoing management of oral intake. Oral hydration is the first line of treatment for dehydration prevention.
An older female resident of an assisted living facility says the following to a nurse: "I am very frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing." The nurse formulates a response based on knowledge of which of the following?
a. Individuals should engage in some type of brain fitness activity a couple of times a week for at least 25 minutes c. Brain fitness activities may include computer-based games, memory training, board games, reading, and engaging in conversation e. Individuals should choose brain exercise activities that are unfamiliar, challenging, and fun -> Brain fitness activities are effective for individuals with normal memory or mild memory problems. -> Physical activity is important and has an impact on improving reaction time and working memory as well as posture, balance, and socialization.
A nurse is educating a group of nursing assistants in long-term care on the prevention of skin tears. Which of the following interventions should the nurse include in the education?
a. Lubricate the resident's skin with moisturizers twice daily b. Ensure that the resident has adequate nutrition and hydration e. Dress the resident in long sleeves and long pants to protect the extremities -> Soapless bathing, tepid water, and moisturizers twice daily are recommended to prevent skin tears. -> Heavy soaps and hot water dry out the skin increasing the risk of skin tears. -> Lifting sheets are recommended as are the use of long sleeves and long pants to protect the extremities.
An older patient complains of pruritus. The nurse suggests which of the following interventions to alleviate the patient's complaint?
a. Use only non-perfumed laundry detergent and fabric softeners b. Avoid sudden temperature changes c. Wear loose-fitting clothing -> Pruritus is aggravated by: -heat -sudden temperature changes -sweating -restrictive clothing -fatigue -exercise -anxiety -perfumed detergents -fabric softeners
An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual?
a. Yoga b. Tai Chi -> Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling.
An otherwise healthy older adult reports having begun to experience problems "holding my water." The nurse shows an understanding of interventions that may help minimize the problem of urinary incontinency when:
a. asking whether the client smokes tobacco. b. assessing the average amount of caffeine the client drinks daily. c. asking if the client has been evaluated for diabetes recently. e. reviewing the client's current medication list -> Risk factors for urinary incontinence include tobacco use, caffeine consumption, and increased urine resulting from diabetes and certain medications.
An older adult is referred to a geriatric nurse practitioner because of changes in memory and reports by family members that "there is something different about her." The nurse practitioner evaluates the older adult for potentially reversible causes for the changes, which include:
a. depression b. delirium e. medication side effects -> Reversible dementia-like conditions include depression, delirium, thyroid disorders, vitamin deficiencies (especially vitamin D), and excessive alcohol intake, as well as side effects from medications.
The nurse interviewing an older adult for a nursing history recognizes that the client is experiencing symptomology inconsistent with normal aging of the urinary tract when the client reports:
a. finding it more difficult in the last few months to start voiding. d. occasionally experiencing pain when urinating -> Difficulty and pain are not characteristics of urination normally attributed to aging. -> In about 10-20% of well older adults, aging of the urinary tract is associated with an increased frequency of involuntary bladder contractions. -> These changes may lead to frequency, nocturia, urgency, and vulnerability to infection
Symptoms of gastroesophageal reflux disease (GERD) in older adults include:
a. heartburn b. regurgitation c. abdominal pain within one hour of eating -> Symptoms of GERD include heartburn, regurgitation, persistent cough, exacerbation of asthma, laryngitis, and intermittent chest pain. -> Abdominal pain within one hour of eating and worsening of symptoms upon lying down are common.
Differences in the presentation of patients with Neurocognitive Disorder (NCD) Alzheimer's Disease (AD) and NCD Lewy bodies (LB) are:
a. individuals with LB develop motor symptoms, and individuals with AD do not. c. the use of traditional antipsychotic medication is contraindicated for individuals with LB. -> Both AD and LB rarely occur to persons under the age of 60. -> Both are characterized by impairments in memory, thinking, language, judgment, and behavior. -> A distinct difference in the two is that persons with LB will eventually develop motor symptoms, and the use of traditional (typical) antipsychotics (e.g., Haldol) is always contraindicated.
A nurse hears a colleague state the following: "Can you believe that Mr. Jones' daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it." The nurse formulates a response based on research that shows:
a. older adults comprise the fastest growing population using computers and the Internet. b. Internet use is less prevalent in individuals over age 75 than those ages 65-74. e. technology has the potential to improve quality of life for older adults. -> Older adults are the fastest growing population using computers and the Internet. -> Internet use does decrease in those over age 75 as compared to older adults less than age 75. -> Older women are the fastest growing group of individuals using social networking sites. -> Older adults use technology for both social reasons and to communicate with health care providers and access health information.
An older patient tells a nurse. "The nurse practitioner told me that these ugly purple bruises on my arms are called purpura and are due to fragile blood vessels. I still don't understand why this happens to me." The nurse responds based on the knowledge that:
a. purpura is due to normal age-related changes. b. the incidence of purpura increases with age. d. individuals who take blood thinners are especially prone to purpura. -> Individuals who are prone to purpura are encouraged to wear protective garments such as long sleeves and long pants.
An older patient asks a nurse, "It seems like all of my friends and I have difficulty sleeping. Is it common among older people?" The nurse formulates a response based on the knowledge that normal age-related changes in sleep include:
a. total sleep time and sleep efficiency are reduced. b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed. d. daytime napping is common -> Sleep requirements do not decrease as one ages. -> Sleep tends to be objectively and subjectively lighter in older adults.
A hospitalized older adult who recently had surgery and a wound infection postoperatively is noted to be losing weight despite consuming his meal trays and snacks. One reason that this might be occurring is:
an injury may trigger inflammatory mediators that increase metabolic rate and impair nutrient utilization -> inflammation-related malnutrition = malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that contribute to an increased metabolic rate and impaired nutrient utilization
Priority intervention: example with law enforcement officer, early retirement, physical complaints, girlfriend just left
assess for suicide
An older adult's diagnosis of sleep apnea is supported by nursing assessment and history data that include:
b. male gender. c. a smoking history of 1 pack a day for 45 years. d. 30 pounds over ideal weight. -> Rest factors for sleep apnea include being male, a smoking habit, and excess weight. -> There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn's disease to the development of sleep apnea.
A nurse caring for a cognitively impaired older adult client shows an understanding of the unique clinical symptoms of constipation in this population when:
b. questioning staff as to whether the client has any unexplained falls in the last few days. c. asking the client to name all of his or her children and grandchildren. d. requesting that the client's temperature be taken now and again in 4 hours. e. reviewing the client's food intake over the last 24-36 hours. -> It is important to note that alterations in cognitive status, incontinence, increased temperature, poor appetite, or unexplained falls may be the only clinical symptoms of constipation in the cognitively impaired or frail older person -> Frequency of defecation is not necessarily an indicator of constipation since it is such a personal characteristic.
While the older African American is at the highest risk for developing Alzheimer's disease, the nurse demonstrates an understanding of this disease process's risk factors when assessing this population's:
blood pressure and serum lipid levels -> They may have identified a gene placing African Americans at about twice the risk for developing AD than their white American counterparts. -> It is possible that additional risk factors are a part of this, specifically, a higher rate of cardiovascular disease.
The greatest risk for injury for a client with progressed Parkinson's disease is:
falls -> If the client becomes off-balance, self-correction is very slow, so falls are common. ->While the client is monitored for depression, suicide is not a common risk for injury.
A nurse at a senior center promotes activity by leading exercise programs. Which of the following is a benefit of such exercise?
improvement of mood -> Physical activity improves cardiovascular health, decreases depression, and helps decrease pain and increase flexibility in the joints.
After first managing the pain being experienced by the client with gout, the treatment focuses on:
preventing systemic involvement by altering the client's diet -> This may be done by avoiding drugs or foods that are high in purine and alcohol, both of which increase uric acid levels. -> Exercise and splinting are not effective in achieving the goal -> Salicylates should be avoided since they will affect the effectiveness of the prescribed medications for gout.
A nurse is interviewing an older woman who is a new patient in an outpatient medical clinic. Which of the following findings by the nurse is considered a risk factor for osteoporosis?
The woman has been taking corticosteroids for 10 years because of chronic pulmonary disease. -> Bone loss is rapid in individuals who take steroids for extended periods of time.
A nurse is providing an educational session on vaccines to a group of older adults. The nurse is discussing the zoster vaccine (Zostavax). Which of the following information should the nurse include in the education?
Zostavax is recommended for all individuals over age 60 that have no contraindications to the vaccine -> Zostavax is recommended for all persons 60 and older who have no contraindications to the vaccine, including persons with a previous episode of Herpes Zoster (HZ) and those with chronic conditions. -> The vaccine does not guarantee that an individual will not get HZ; however, individuals who get the vaccine cut their risk in half and if they do get HZ, it is likely that they will get a milder case.
An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on the knowledge that:
a cochlear implant directly stimulates the auditory nerve. -> A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.
A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version (S-MAST-G) to an older adult. The older adult receives a score of "2." The nurse knows that this score is indicative of:
a problem with alcohol. -> A score of 2 or more on the S-MAST-G indicates that there is an alcohol problem. T -> This scale does not rate the severity of the problem.
The nurse preparing educational information on common mental health disorders among the older adult population should include:
a written depression screening tool -> Depression is the most common mental health disorder of later life.
Which question has priority when assessing a client for risk factors related to the use of sildenafil (Viagra)?
"Are you currently being treated for hypertension?" -> CI with nitrates
A nurse who is caring for an older patient with bipolar disorder knows that the patient needs additional education when the patient states:
"Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults. -> DEPRESSION is the most commonly diagnosed disorder in older adults -> Bipolar disorders tend to level out in later life, and individuals tend to have longer periods of depression. -> Relapses in older adults are usually precipitated by medical problems. -> Older adults tend to be "rapid cyclers," cycling from mania to deep depression in a much shorter period of time than they did when they were younger.
A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse's teaching plan?
"Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise." -> Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. -> Hearing aids do not restore hearing to normal. -> Medicare does not cover the cost of hearing aids.
How should the nurse reply when an older adult asks, "How much alcohol is good for you?"
"Experts in the field recommend only one regular sized drink a day." -> Clinically significant adverse effects can occur in some individuals consuming as little as two to three drinks per day over an extended period. -> Recommended that individuals over the age of 65 limit alcohol consumption to no more than one standard drink per day -> Substance Abuse and Mental Health Services Administration (SAMSHA) recommends a maximum of two drinks on any drinking occasion (holidays or other celebrations)
When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is confident that client education on the condition's contributing factors has been effective when the client states:
"I've cut way back on my caffeinated coffee, teas, and sodas." -> Increased caffeine use can be a contributing factor to RLS. ->There is no research to confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. -> A potassium deficiency has not been identified as a contributing factor to RLS.
An older client diagnosed with dementia resides with his daughter. When the homecare nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, "I don't know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him." How will the nurse respond to the client's daughter?
"Let's try to figure out what your father was trying to say with his behavior." -> Dementia often interferes with the person's communication and the ability to understand and express thoughts and feelings. The focus needs to be on what the person is attempting to communicate through behavior.
The daughter of an older hospitalized patient tells a nurse: "I am worried about my father. His memory is sharper when he is at home. He is forgetful, but is functional. Since he has been hospitalized his memory problems are much worse." The best response by the nurse is:
"Memory changes are often worse when an individual is in an unfamiliar or stressful situation." -> Short-term memory is impacted more than long-term memory
A nurse is using the function-focused care approach to care for a hospitalized older adult. The nurse is assisting the patient to transfer from the bed to a chair. Which of the following statements by the nurse is most congruent with this approach to care?
"Place both of your hands on the overbed trapeze and pull yourself up to a sitting position." -> FFC is based on a philosophy of care where the nurse acknowledges the older adult's physical and cognitive abilities and encourages the individual to function at the highest level possible.
An older person is admitted to the hospital with an exacerbation of congestive heart failure. The nurse notes that the patient complains of severe itching at night and has a red rash on her torso. The patient is diagnosed with scabies. The patient asks the nurse, "How did I get something like this?" The best response by the nurse is:
"Scabies is highly contagious and spreads easily through physical contact." -> It is not limited to older adults, and age-related changes in the skin do not cause it or make a person more susceptible. -> Individuals with multiple chronic conditions are not more likely to develop scabies than other individuals. -> There is no evidence that medications can make an individual more susceptible
A nurse identifies that an older adult needs more education on nutritional needs when the older adult states the following:
"Since I am an older person, I need more calories because my metabolic rate is slower" -> Older adults need fewer calories because they may not be as active and metabolic rates slow down. -> require the same amount of nutrients for optimal health outcomes
An older adult who is within a normal weight range asks a nurse, "I have heard that it is important to limit the amount of fats in my diet, but I don't know how much I should be taking in daily. Can you help me?" The best response by the nurse is:
"Since you are at your ideal weight, you should limit your daily fat grams to half your weight." -> A simple technique to determine how much fat a person should consume is to divide the ideal weight in half and allowing that number of grams of fat.
An older patient asks a nurse, "I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is:
"Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep." -> Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. -> Sleep problems are common in older adults -> There are many nonpharmacologic interventions that can be utilized to improve sleep.
An older client in an adult day care program tells the nurse, "I'm very stressed because another neighbor passed away." The most therapeutic response by the nurse is:
"Tell me what you did when your other neighbor passed away." -> Application of what one has learned from previous situations can help dissipate the intensity of stress. -> Denial of the stressful event and focusing upon blessings or happiness will not lessen the stress and may in turn intensify it.
An older resident in a senior community tells a nurse: "I am really worried. I joined an exercise class, and I just learned everyone's name yesterday, and I cannot remember them all today. Am I developing Alzheimer's disease?" The best response by the nurse is:
"There is no reason to be concerned. Short-term memory decreases with age." -> Even though some older adults show decrements in the ability to process information, the majority of functioning remains intact. -> Age-associated memory impairment is used to describe memory loss that is considered normal for one's age and educational level. -> May include slowness in processing, storing, and recalling new information and difficulty remembering names and words.
A nurse is working with an older individual who has recently started an exercise program. The individual tells the nurse, "This exercise thing is really hard, and I absolutely hate walking on a treadmill going nowhere. I think I am going to call it quits." Which of the following responses by the nurse will be most effective in encouraging the individual to remain in the program?
"What types of exercise do you enjoy doing?" -> Providing choices, as well as making exercise fun and entertaining, is a strategy to sustain participation in an exercise program.
A nursing student asks the instructor, "Our textbook discussed the obesity paradox in older adults. I am not sure I understand; isn't obesity bad for everyone?" The best response by the instructor is:
"While there is evidence that obesity in younger people lessens life expectancy, it remains unclear whether overweight and obesity are predictors of mortality in older adults."
A 75-year-old female asks a nurse "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is:
"You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week."
Skin tear Interventions
-> *Non-occlusive dressing aka NO tegaderm* -> use moist gauze -> Keep moist, place skin flap into place, ointment, wrap it -> Soapless bathing, tepid water, and moisturizers twice daily are recommended to prevent skin tears. -> Heavy soaps and hot water dry out the skin increasing the risk of skin tears. -> Lifting sheets are recommended as are the use of long sleeves and long pants to protect the extremities.
Dysphagia precautions
-> have the dysphagia patient sit upright at 90 degrees and to remain upright for an hour following the meal -> Have the patient swallow twice for every mouthful of food given.
Dementia
-Alzheimer's: -> neurofibrillary tangles and amyloid plaques, 4 A's (aphasia, apraxia, abulia, agnosia) -Lewy body: Lewy bodies present, hallucinations, Parkinson-like movement
Fecal Impaction
-Sx: Fever, small diarrhea episodes -Management requires digital removal of the hard, compacted stool from the rectum with lubrication containing lidocaine jelly
Obesity prevalence
-The proportion of older adults who are obese has doubled in the past 30 years -More than one-third of individuals 65 years and older are obese with a higher prevalence in those 65-74 years than in those 75 years and older
Obesity paradox
-obesity in younger people contributes to a decreased life expectancy -in older adults, it is not clear whether obesity is a predictor of mortality -Recent evidence demonstrated that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight -Persons who increased or decreased BMI have a greater mortality risk than those who have a stable BMI, particularly in those aged 70-79
Fluid intelligence
-our ability to reason speedily and abstractly; tends to decrease during late adulthood -the ability to see abstract relationships and draw logical inferences -Enables ability to identify and draw conclusions regarding complex relationships -> decrease performance on tests requiring fluid intelligence
crystallized intelligence
-our accumulated knowledge and verbal skills -the ability to retain and use knowledge that was acquired through experience -associated with wisdom, judgment, and life experiences -> increase performance on tests using crystallized intelligence
An older woman asks a nurse, "You always seem to be telling me that I need to drink more water. How much water do I really need to drink?" The nurse bases her response on the knowledge that older adults should consume at least:
1500 mL of fluid per day -> exception is those with a fluid restriction
An older adult asks a nurse, "I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?" The nurse bases a response on which of the following?
20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein
Many older adults have a vitamin B12 deficiency. Reasons for this include which of the following?
A. Normal age-related changes in the stomach include a lower production of gastric acid making vitamin B12 absorption less efficient C. Proton pump inhibitors, a frequently prescribed medication in older adults, impairs absorption of vitamin B12 from food E. Certain antibiotics and anticonvulsant medication increase the risk of vitamin B12 deficiency -> Normal age-related change in the stomach is the production of less gastric acid, which makes vitamin B12 absorption less efficient. ->For most older adults, intake of vitamin B12 is usually adequate. -> the major source of vitamin B12 is not sunlight
A nurse is preparing to hand feed an older adult with a history of a right cerebrovascular accident (CVA) with facial weakness and dysphagia. Which techniques should the nurse utilize when feeding this patient?
A. Sit the patient upright in a chair at 90 degrees. E. Have the patient swallow twice for every mouthful of food given. -> have the dysphagia patient sit upright at 90 degrees and to remain upright for an hour following the meal ->This patient has a history of a right CVA, which would mean that the patient has left-sided weakness. The food needs to be placed in the nonimpaired side of the mouth (right side) (think opposite is impaired)
A nurse is caring for an older adult with Parkinson's Disease. The patient is receiving the medication levodopa-carbidopa. The nurse understands that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following?
Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal
An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following?
Age related macular degeneration -> Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration.
You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose?
An orange-carpeted room with soft lighting and yellow walls -> Light colors such as red, orange, and yellow are more easily seen by aging eyes -> Softer lighting will help reduce some of the glare and is also easier seen by aging eyes ->Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem -> Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare
An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging?
Assessing the client for both depression and anxiety -> Substance abuse in older adults is frequently a coping mechanism to deal with loss, anxiety, or depression -> There is no evidence about the success or lack of success of treatment programs for older adults because they have not been adequately investigated. -> Nutritional counseling and the discussion of the long-term effects of alcoholism may be appropriate but not specific to the older adult client
Which intervention best addresses the principle that is the basis for communicating with a client experiencing postsurgical delirium?
Assuming that the client's statements are an attempt to express needs -> Assuming that communication and behavior are meaningful and an attempt to tell us something or express needs is vital to effective care planning for the delirious client.
Which intervention to manage wandering in clients in a long-term care facility should be implemented?
a. Camouflaging doorways b. Close observation to identify the person's individual patterns c. Engaging the person in social interactions e. Providing enclosed pathways for walking -> Restraints are not an effective intervention for wandering
A patient is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease?
Osteoporosis is common in females after menopause. b. Osteoporosis is a degenerative disease characterized by a decrease in bone density. d. Osteoporosis can cause pain and injury. -> Osteoporosis is not a congenital disease -> While a low intake of calcium is a factor, there are dietary sources of calcium other than dairy products. -> Passive range of motion cannot prevent osteoporosis.
. An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse?
Examine the resident's ears for cerumen impaction -> When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. -> Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. -> Raising one's voice is not effective; it often makes hearing more difficult. -> Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.
Which intervention has priority before touching a client's consent zone?
Explaining why the area will be touched while asking permission -> The consent zone requires the nurse to seek out or ask permission to touch or initiate procedures to these areas. -> The touch should not occur unless it is absolutely necessary. -> Draping is appropriate but doesn't occur until permission is granted. -> Having another nurse present is not always necessary unless the touch is by a male nurse upon a female client.
A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an expected assessment finding for this patient?
Fluctuation in symptoms -> A hallmark of delirium is fluctuation in symptoms -> Patients with delirium typically have decreased attention spans and an altered sleep-wake cycle. -> Classic symptoms of delirium do not involve changes in appetite; however, patients often have a decreased appetite.
A nurse is planning an educational session on osteoporosis to be given at a senior center. Which of the following should be discussed as preventive measures for osteoporosis?
Following a diet with adequate amounts of calcium and vitamin D -> The recommendation for DXA/DEXA scan is every 2 years -> Exercise recommendations are for weight-bearing exercise.
A 78-year-old patient has a history of osteoarthritis and lives alone in a two-story home. The bathroom is on the first level and the bedroom is on the second level. The patient states, "I am so upset. I have been wetting the bed at night." What type of incontinence does the patient most likely have?
Functional incontinence -> Functional incontinence is defined as incontinence that is due to the individual being unable to get to the toilet as a result of barriers, including environmental barriers.
A nurse is assessing an older patient and notes a cluster of fluid-filled vesicles on the right thoracic area. The nurse suspects HZ. The patient asks the nurse, "I really don't understand how I got shingles. I don't even know anyone who has this infection." The nurse includes which of the following in formulating a response to the patient?
HZ is caused by a reactivation of dormant varicella zoster virus within the sensory neuron of the dorsal root ganglion -> HZ is infectious until the lesions are completely crusted over. -> Individuals do not have to have direct contact with someone who has either chickenpox or HZ in order to have a reactivation -> Other factors such as illness and stress can cause the reactivation.
Which of the following manifestations would a nurse expect in a 70-year-old patient who has the diagnosis of osteoarthritis?
Heberden's nodes on the distal phalanges -> Swan neck deformity and subluxation of the fingers are common in RA -> An enlarged great toe is characteristic of gout.
An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 AM, she awakens from sleep insisting that her daughter is in the other room and wants to see her. Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client's record, what data would be considered a primary risk factor for the delirium?
History of dementia
Which outcome regarding the effects of touch on the skin is not supported by current research?
Improves skin integrity -> Research supports: Brings about sensory stimulation, Helps relieves physical and psychosocial pain, Is known to reduce anxiety and tension -> There is no evidence that therapeutic touch improves skin integrity.
A nurse implements a nursing care plan for a patient with constipation. Which of the following should the nurse include in the plan?
Increasing fiber in the diet ->Fluid intake of at least 1.5 L/day is the cornerstone of constipation therapy -> A gradual increase in fiber, either as supplements or incorporated into the diet, is generally recommended. -> Fiber helps stools become bulkier and softer and move through the body more quickly -> Physical activity is important as an intervention to stimulate colon motility and bowel evacuation. Daily walking for 20-30 minutes, if tolerated, is helpful, especially after a meal. -> Aluminum hydroxide antacids are known to be constipating
Kyphosis in the older adult can be a result of which of the following?
Osteoporosis -> Individuals can lose as much as 3 cm or more in height and develop a "c" shape to the vertebral column.
A patient tells the nurse, "Every time I laugh or cough, I wet myself." Which type of urinary incontinence is this patient describing?
Stress -> Stress incontinence is defined as the loss of a small amount urine with activities that increase intraabdominal pressure such as coughing, sneezing, exercise, lifting, or bending
Which of the following statements describing oral care for the older population is correct?
Regular dental examinations can prevent tooth loss and improve the ability to chew healthful foods. -> Losing one's teeth is not a normal part of aging; about one-quarter of adults over age 65 are edentulous. -> Oral cancers occur more often in older individuals. Oral examinations can assist in early identification and treatment. -> Medicare does NOT provide any coverage for oral care services.
A nurse plans for the discharge of a 75-year-old patient who has the diagnosis of osteoporosis. Which of these actions would the nurse consider first?
Remove clutter from the floors of the home. -> Individuals with osteoporosis are very high risk for falls. The most serious health complication of osteoporosis is the morbidity and mortality associated with a fall. -> There is no evidence that a high-protein diet is important for an individual with osteoporosis.
What intervention should a nurse implement when an older male diagnosed with dementia is observed masturbating in the unit's dayroom?
Remove the resident from the dayroom and complete an assessment of his behavior. -> When sexually inappropriate behavior occurs, it should be assessed, like any other behavior, as to cause, precipitating factors, and response to interventions. -> It is appropriate to remove the resident from the dayroom because the behavior may be distressing to staff and other residents.
A nurse is discussing the importance of exercise with a 78-year-old female who states: "I know I should be exercising, but I have arthritis in my knees and it is painful. Can you recommend a type of exercise that would be beneficial and cause me less pain?" Which of the following exercises should the nurse recommend?
Swimming -> The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. -> Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations
A nurse in a long-term care facility notes that an older resident with Alzheimer's disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident's sleep problems?
Taking the resident outside in the garden for 45 minutes daily -> Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep -> Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia -> Educating the resident about the association between AD and insomnia may be feasible depending on the resident's mental status but will not necessarily ameliorate the problem. -> . Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances.
Based on recent studies, which statement regarding touch and touch zones is most accurate?
The comfort of touch depends on place, situation, social status, and age. -> Older adults are frequently isolated and are not touched. -> There is no evidence to support the statement that graduate nurses touch patients less than nursing students. -> The zone of intimacy is within an arm's length of the individual, and it is the space used for comforting, protecting, and lovemaking.
A nurse is observing a nurse aide perform denture care for a resident in the nursing home. The nurse recommends that the nurse aide receive additional education on denture care when the nurse observes which of the following?
The nurse aide uses toothpaste to clean the dentures. ->Toothpaste is not used to clean dentures since it abrades denture surfaces. -> Correct methods: The nurse aide utilizes a specially designed denture brush to clean the dentures. Stores the dentures in a denture cup filled with denture cleansing solution. Places a face cloth in the sink and fills the sink half full with water.
An older man who recently had a myocardial infarction is being discharged home from the hospital. He tells a nurse, "I am really worried about having sex with my wife. I am afraid that I am going to have another heart attack." The best response by the nurse includes which of the following?
a. "If you are able to engage in mild to moderate physical activity without symptoms, you can resume sexual activity." c. "It is best if you avoid eating a large meal for several hours before you have sexual relations." d. "If you have chest pain while having sex, stop and rest, and take your nitroglycerin." e. "You might want to consider some alternate positions that avoid strain." -> Those with a complicated MI may need to resume sexual activity gradually over a longer period of time
When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention?
a. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications." d. "While there may be some short-term memory loss, most individuals find that their memory comes back within a few days." e. "ECT results in a more immediate response to symptoms." -> ECT is equally effective in older adults as in younger adults. -> It is used for individuals with depression, not psychotic ideation. ->There is some short-term memory loss associated with ECT; however, it does resolve within a short time frame.
A nurse practitioner is using the PLISSIT model to guide a discussion of sexuality with an older patient in the geriatric clinic. Which of the following are congruent with the PLISSIT model?
a. "What concerns or questions do you have about fulfilling your sexual needs?" b. "Let me tell you about the impact of your cardiac disease on sexual activity." c. "I have a few suggestions on lubricants that might make intercourse more comfortable for you." -> The steps of the model are: -Permission: Obtain permission from the client to initiate sexual discussion -Limited Information: Provide the limited information to function sexually -Specific Suggestions: Offer suggestions for dealing with problems -Intensive Therapy: Refer as appropriate for complex problems that require specialist intervention
An older adult is diagnosed with Alzheimer's Disease. The nurse knows that this diagnosis is made on the presence of which of the following?
a. A decline from a previous level of functioning c. An insidious onset d. A gradual decline in cognitive abilities -> A diagnosis of a NCD due to AD requires (1) a decline from a previous level of functioning, (2) an insidious onset, and (3) a gradual decline in cognitive abilities. -> It is important to note that the changes are "greater than expected for the person's age and educational background" -> Delirium: Fluctuation of symptoms over the course of a 24-hour period. The cognitive changes worsen in the evening hour.
A nurse understands that the pathophysiology of Parkinson's Disease includes which of the following?
a. A deficiency of the neurotransmitter dopamine c. A reduction of dopamine receptors d. An accumulation of Lewy Bodies, especially in the basal ganglia -> The presence of neurofibrillary tangles and amyloid plaques in the brain is seen in Alzheimer's Disease.
A nurse is assessing an older patient with new onset confusion using the Confusion Assessment Method (CAM). The nurse understands that in order to have a diagnosis of delirium when using the CAM, the patient must exhibit which of the following?
a. Acute onset of symptoms or fluctuating course b. Inattention -> The individual must have (1) acute onset or fluctuating course and (2) inattention and (3) either disorganized thinking or altered level of consciousness.
A nurse is providing glaucoma education for a group of older adults in a senior center. The nurse knows that the following groups are most likely to develop glaucoma.
a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes ->African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among other high-risk groups. -> Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups.
A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after she had outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. She refused to return to her room and stated that there were "bad men" in her room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. She was widowed 1 year ago. The nurse suspects that she has delirium. What are the patient's risk factors for delirium?
a. Age of 92 c. History of dementia e. Recent cataract surgery -> There is no evidence that living in an assisted living facility or being female increase risk of delirium.
A 74-year-old woman who is in the hospital for rehabilitation following hip replacement has been experiencing incontinence since admission. Which of the following interventions are likely to facilitate the restoration of the patient's bladder function?
a. Assess the patient's recent voiding pattern. d. Assist the patient to use the bathroom. -> Assisting the patient to the bathroom has many beneficial aspects to it and it provides a private setting where the patient is in the most normal physiological position to urinate.
A nurse is developing an educational session for a group of older adults at a senior center. Which of the following would the nurse include in the education?
a. Attention span, language, and communication skills typically remain stable with increasing age b. Older brains slow down and take longer to process constantly increasing amounts of information c. In order to preserve brain function, it is important to engage in challenging cognitive activities -> Older adulthood is no longer seen as a period when cognitive development is halted; it is a life stage where unique capacities are developed. -> Centenarians and super-centenarians have a lower prevalence of dementia then those under age 100.
A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan?
a. Avoid lifting heavy objects after the surgery b. Avoid bending from the waist after the surgery c. Take stool softeners as needed -> Post-cataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. -> Fall prevention is also very important as is complying with eye drop administration. -> Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. -> There usually is not a dressing over the operative site, and not for 10 days.
An older patient is concerned that her neighbor was recently diagnosed with Alzheimer's Disease and asks a nurse what can be done to decrease the risk of Alzheimer's Disease. The nurse includes which of the following in the response to the patient?
a. Maintain blood pressure within normal limits b. Smoking cessation c. Maintain control of blood sugar (hemoglobin A1C < 7 ) Recommendations to decrease risk of neurocognitive disorders include maintaining blood pressure within normal limits, maintaining low-density lipoprotein cholesterol 100, maintaining hemoglobin A1C 7, taking aspirin (81 mg enteric coated) for persons with risk for heart disease, maintaining optimal control of heart failure, and smoking cessation
A nurse is planning a fall prevention education refresher session for the residents of a long-term care facility. The individuals are all cognitively intact and range in age from 80 to 100. The previous education on fall prevention was presented 2 months ago. What special considerations should the nurse take in relation to teaching this group of older adults?
a. Make sure that all pamphlets are in large readable font (14-16 points) and include upper and lower case lettering d. Ensure that there is adequate lighting in the room and that the temperature is comfortable e. Provide ongoing positive feedback during the session -> When educating older adults it is important that it is pertinent and build upon information that they already possess. -> It is a myth that all older adults experience memory problems. -> It is important to provide adequate time for learning and to use self-paced techniques.
A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states that he drinks two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol?
a. Naproxen for pain c. Prozac for depression -> There is no evidence that multivitamins, cyclooxygenase-2 (COX II) inhibitors, or beta-blockers interact with alcohol.
Which of the following are subscales on the Braden Scale for predicting pressure ulcers?
a. Nutrition b. Moisture c. Mobility -> The six subscales of the Braden Scale are sensory perception, activity, mobility, moisture, friction and shear, and nutrition.
A nurse is caring for an older adult who has a gastrostomy tube. The nurse is developing a care plan related to oral care. Which of the following should the nurse consider for this patient?
a. Oral care should be provided every four hours. b. Teeth should be brushed with a toothbrush after each tube-feeding. -> Tube-feeding is associated with significant pathologic contamination of the mouth, greater than in individuals who receive oral feeding. -> Oral care should be provided every 4 hours for patients with gastrostomy tubes and teeth should be brushed with a toothbrush after each feeding to decrease the risk of aspiration pneumonia ->Lemon glycerin swabs should never be used for oral care, as they dry and inhibit saliva production. -> Foam swabs do not remove plaque as well as toothbrushes. -> Oral care is required even if the individual is edentulous.
A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching?
a. Rest the joint during the acute gout attack. c. Increase fluid intake to 2 L/day. d. Avoid foods high in purine. e. Avoid alcoholic beverages. -> Individuals who are having an acute attack of gout should not take salicylates for pain. ASA is a salicylate.
A diagnosis of Parkinson's disease is made based on the presence of which of the following symptoms?
a. Rigidity b. Resting tremor c. Bradykinesia -> A diagnosis of Parkinson's Disease is made based on the presence of the following symptoms: resting tremor, rigidity, bradykinesia, asymmetric onset, as well as a positive response to levodopa.
An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: "Is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response?
a. Strict control of blood glucose levels is important in slowing disease progression b. Laser photocoagulation treatments can stop progression of the disease c. Control of blood pressure and cholesterol levels are important steps slowing disease progression -> Laser treatment can reduce vision loss in 50% of patients. -> Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.
A nurse is conducting an assessment of an older patient's eyes. The nurse expects to see which of the following normal age-related changes of the external eye?
a. The eyelids are less elastic and droopy b. The eyes are very dry c. The eyelids may not close completely e. The lower lid may be turned outward -> Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. -> Loss of eyelashes is not a normal age-related change.
A nurse in a long-term care facility is approached by an older resident who is crying and states: "You need to help me. The mean little men are in my room again. They are watching me from the corner and they are laughing at me. Make them go away." The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse?
b. "Can you tell me what you are so frightened of?" c. "I will do my best to keep you safe." d. "I understand that you are very frightened and upset." -> When dealing with a patient with frightening delusion, the nurse needs to be understanding, but not pretend to agree with the delusions. -> The nurse needs to ask what is troubling to the patient and provide a reassurance of safety. -> It is important to try and understand the patient's level of distress and what the patient is experiencing
A nurse in a long term care facility is concerned that a 94-year-old resident with dementia is losing weight. Upon assessment, the nurse notes that the resident, who is able to feed herself independently, consumes less than 50% of each of her meal trays. Which of the following strategies can the nurse utilize to improve this resident's intake?
b. Assign a nursing assistant to sit with the resident as the resident eats. c. Serve the resident finger foods. d. Serve the resident one dish at a time. e. Alter the dining ambience to reduce distractions. -> Because the resident can feed herself, it is important to promote that level of independence for as long as possible.
Which information will the nurse manager include when discussing the major differentiation between delirium and dementia with novice nurses?
b. Delirium requires increased monitoring at night. d. Dementia results in a steady decline in cognitive abilities. e. Delirium is characterized by fluctuations in alertness. -> It is the client experiencing dementia who will over the course of the illness learn to confabulate to cover up his or her memory losses -> The delirious client is more likely to show fear through facial expressions.
A nurse is educating a group of older adults on the benefits of an exercise program. The nurse includes education on when not to exercise. Which of the following should the nurse include in the education?
b. Do not exercise if your blood pressure is greater than 200 systolic and 100 diastolic d. Do not exercise if a joint that you are using to exercise is red, warm, and painful e. Do not exercise if you have a fever and muscle aches -> Older adults are advised to avoid exercise if their resting heart rate is over 120, not 80 -> It is important to wait 2 hours after a heavy meal before engaging in vigorous exercise, but leisurely exercise such as a walk is fine
A nurse is teaching a group of 65-year-old patients about reducing the risk of osteoarthritis. Which of the following would the nurse discuss as a modifiable risk factor for osteoarthritis?
b. History of joint injuries e. Obesity -> Gender and advancing age are nonmodifiable risk factors for osteoarthritis. -> There is no evidence that coffee or caffeine has any relationship to the development of osteoarthritis.
A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient's skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient?
b. Lower extremity weakness d. Sunken eyes -> Older adults often present atypically when dehydrated. -> Skin turgor over the sternum is not a reliable marker in older adults due to the loss of subcutaneous tissue with aging -> High fever and cough can be associated with many other conditions and are not typically signs of dehydration.
A nursing student is preparing a presentation on arthritis. The nursing student knows that differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include that:
b. OA is a localized process, whereas RA may be systemic. c. OA usually impacts distal interphalangeal joints; RA impacts proximal interphalangeal joints. -> OA has an insidious presentation, and RA has an acute presentation. -> OA presents with joint stiffness, which resolves in LESS than 20 minutes, and RA presents with joint stiffness that lasts MORE than 20-30 minutes -> OA is initially treated with nonpharmacological treatments such as heat or exercise, and RA is treated with medications disease-modifying antirheumatic drugs (DMARDs) immediately after diagnosis.
Two older residents of a long term care facility are engaged in a romantic relationship. The residents are both cognitively intact. A nurse finds the two residents engaging in sexual activity. The response of the nurse includes which of the following?
b. Provide a safe private area where the residents can engage in sexual activity. d. Provide education for the residents using the PLISSIT model -> Residents in a long term care facility have the right to engage in sexual activity. -> The role of the nursing staff is to provide a safe and private area for the residents and to provide education on safe sexual practices and be open to answering questions and providing information to the residents. -> Calling the residents' family members is also not appropriate as they are cognitively intact and able to make their own decisions.
A nurse is developing a care plan for an older adult in a long-term care facility that has a nutritional problem. Which of the following interventions are appropriate to ensure adequate nutrition?
b. Supervise the resident during meals c. Provide a pleasant eating environment d. Provide nutritional supplements for the resident e. Assess the resident for ability to feed themself ->Feeding a resident is not indicated unless it is known that the resident cannot feed himself/herself -> It is important to promote independence as much as possible
A long term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit?
b. Taking as many residents as possible outside for 30 minutes daily c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM d. Avoiding waking residents for routine care during the night e. Limiting caffeine and fluids before bedtime -> Strategies to promote sleep for individuals in long term care and hospitals include allowing the resident to stay out of the bed and the room for as long as possible before bed, and not placing them in bed too early.
A nurse is caring for an older adult in a hospital who has an indwelling catheter. The nurse assesses the patient based on the knowledge that which of the following are correct indications for an indwelling catheter?
b. To manage acute urinary retention c. To assist in healing of open sacral or perineal wounds in incontinent patients d. To accurately measure urinary output in critically ill patients -> Urinary catheters are not an appropriate intervention for the management of incontinence and do not prevent falls related to toileting in hospitalized patients.
An older resident in a long-term care facility reports to the nurse that she has been noticing changes in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with:
cataracts -> Signs of cataracts include the appearance of: -halos around objects as light is diffused -blurring -decreased perception of light and color giving a yellow tint to most objects -sensitivity to glare.
An older adult's nutritional status is screened by a nurse using the Mini Nutritional Assessment (MNA). The older adult scores a score of "10" on the screening portion of the tool. The best action by the nurse is to:
complete the assessment portion of the tool -> If an individual scores less than a 12 on the screening portion of the tool, then the assessment portion must be completed -> It is validated for use in individuals over age 65 -> The assessment portion needs to be completed before any interventions or referrals are taken, as the information that is obtained in the assessment will guide the choice of interventions.
An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse that, "On top of all I've had to endure, now I've got this flu!" In rendering care for this client, the nurse recognizes that:
crisis and stressful situations may produce emotions that erode the health of the older people. -> Sustained stress can lead to physical consequences, particularly in older adults who have less reserve than younger individuals. -> Learned helplessness occurs when an individual has a perceived lack of control, which erodes the person's personality.
An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include:
d. age-related hearing impairment. e. excessive and loud noise. -> middle ear tumors, cerumen impaction, and external and middle ear infections are all associated with conductive hearing loss.
In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include:
involving the client in the process of oral hygiene, such as using the hand over hand technique to brush the client's teeth -> With uncooperative individuals, it is important for the caregiver to be at eye level and explain all actions with step-by-step instructions -> Speaking to the client sternly, having another nurse aide hold the patient's mouth open, or performing oral hygiene without an explanation will only serve to agitate the patient
Cognitively intact residents engaging in foreplay
leave them alone
A client who reported "a problem sleeping" shows an understanding of good sleep hygiene by:
limiting the afternoon nap to just 30 minutes -> Exercise should be completed at least 4 hours before retiring while a bedtime snack is acceptable if the food is light and easily digested -> Computer-focused activities are not generally encouraged as a part of a bedtime routine
Symptoms of HIV are often under-recognized in older adults because:
many of the classic symptoms are also common to other conditions common in older adults. -> The classic symptoms of weakness, anorexia, and fatigue are common to other conditions common in older adults; additionally, they may also be attributed to normal age-related changes -> The incidence of AIDS in older adults is increasing, rising faster among older adults than among younger adults. -> The symptoms are identical in older and younger populations. -> AIDS progresses more quickly in older adults than it does in younger adults.
An 89-year-old hospitalized female patient tells a nurse, "I go to the bathroom really often, but I manage this by not drinking too much before I go to bed so I can sleep for the night." The patient has no pain or discomfort with voiding. The nurse considers this finding to be a:
normal age-related change in an 89-year-old woman. -> A decreased bladder capacity is a normal age-related change. -> Urinating frequently with no other symptoms is not a manifestation of infection or diabetes.
A nurse assesses a nursing home resident's pressure ulcer to be a "healing stage III." The primary reason reverse staging is never used is because:
not all tissue layers are replaced as a wound heals, and the healed skin is not as strong as it originally was. -> The wound fills with granulation tissue composed of endothelial cells, fibroblasts, collagen, and extracellular matrix. -> Muscle, subcutaneous fat, and dermis are not replaced. -> The healed skin is not as strong as it originally was. -> Reimbursement in long-term care is not the primary reason for not using reverse staging.
An older adult says to the nurse, "I don't know why I can't handle booze like I used to when I was younger." The nurse's response is based on the knowledge that:
older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol -> Age-related changes such as increased body fat, decreased lean muscle mass, and decreased total body water content alter absorption and distribution of alcohol, increasing blood alcohol levels -> Age-related neurological changes do not impact BAC -> Slowed reaction time does not impact BAC -> Cognitive changes do not impact BAC; furthermore, not all older adults experience cognitive changes
An older widow who is a newly admitted resident of a long-term care facility develops a romantic relationship with a male resident. When the resident's daughter demands that the staff "put a stop to this sexual behavior right now," the nurse's response is based on the understanding that:
older adults need to express love and intimacy. -> The needs of older adults for love and intimacy remain the same regardless of whether the individuals are institutionalized. -> Meeting the needs of the residents for sexuality and intimacy is as important as the need for food and hydration. -> Sexual desire is present in older adults. Sexual activity is not dangerous for older adults. -> Some accommodations for chronic conditions might be required