Jensen Ch. 28: Older Adults

A nurse who coordinates care in a public health unit is teaching staff how best to communicate with the older clients who dominate the demographic area. Which of the following directives should the nurse provide?

"Allow your client's stamina and abilities to guide the pace and content of your interactions."

Which question asked by the nurse is appropriate when assessing instrumental activities of daily living (IADLs)?

"Are you able to prepare meals for yourself?"

The nurse notes that the left arm of an older woman is larger than the right. Which question is best for the nurse to ask to determine the suspected cause of this finding?

"Have you had a mastectomy of the left breast?"

An older client asks why the leg muscles have become flabby over the last few years. What should the nurse respond to this client?

"It occurs with aging but is encouraged by sitting too much."

An older client who typically weights 160 lbs. appears withdrawn and disheveled and causes the nurse to be concerned since the last visit a month ago. For which body weight should the nurse conduct a complete nutritional assessment?

152 lbs.

A nurse completes a Geriatric Depression Scale for an older adult client. The nurse determines that the client is not depressed by which score?

9

How do many older adults define their health?

Ability to function independently

The nurse is conducting a functional assessment of an older adult client. The nurse should focus questions on which area?

Activities of daily living

The nurse is assessing an older adult with intact cognition. A younger family member is present. The client is slightly hearing impaired, so the nurse must speak up. What should the nurse never do in relation to the client in this situation?

Address the family member if the client hesitates when answering a question

In the older adult, which changes in the peripheral vascular system can increase blood pressure?

Arterial walls are less elastic and stiffen

An older adult client who enjoys good overall health has sought care because of a recent onset of weakness and fatigue. The client is unaware of any precipitating events. How should the nurse proceed with assessment?

Assess the client for signs and symptoms of anemia.

During an assessment of an elderly client, the nurse notes a decrease in pupil size and a slowed reaction of the pupil to light. Accommodation and convergence are normal. Based on these findings, what should the nurse emphasize with client education?

Avoid driving at night

The nurse notes that it takes an older client 45 seconds to complete the "get up and go" test. Which activities of daily living should the nurse plan to assist the client with completing? Select all that apply.

Bathing Climbing stairs Getting in and out of bed

An elderly male client presents to the health care clinic with reports of urinary frequency, nocturia, and difficulty starting his stream. A nurse knows that the most common cause of these symptoms is what condition?

Benign prostatic hypertrophy

Which of the following changes in vision is expected with normal aging?

Blurring of near vision

When examining the eyes of an elderly client, the nurse observes a brownish discoloration of the lens. The nurse interprets this finding as being suggestive of what health problem?

Cataracts

A nurse has assessed an elderly client and is preparing to analyze the assessment data. Which of the following would the nurse need in order to accurately perform data comparison?

Client's usual daily patterns

A client's medical assessment reveals no heart disease. An electrocardiogram is performed and a dysrhythmia is noted. The nurse interprets this finding as most likely reflecting which age-related change?

Collagen deposits around pacemaker cells

After teaching a group of students about geriatric syndromes, the instructor determines that the teaching was successful when the students identify what as an example?

Confusion

A home care nurse is assessing an older adult's functional status. The nurse should identify what as an instrumental activity of daily living?

Cooking

The nurse is preparing to perform a pelvic examination on an elderly female client. What would the nurse expect to find?

Decreased vaginal secretions

Which of the following accompanies decreased ovarian function?

Decreased vaginal secretions

A nurse recognizes that a sudden change in an elderly client's cognition accompanied by a change in the level of alertness may be an indication of what condition?

Delirium

A 70-year-old retired auto mechanic comes to the office because his neighbor is concerned about the client's memory. The client admits to misplacing his keys more often and forgetting what he is supposed to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different provinces; and he has limited his activities because the people he interacted with were "his wife's friends, not his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. The nurse performs a mini-mental state examination and obtains a total score of 24 out of 28. Based on this information, what is the most likely diagnosis?

Depression

A nurse is using the Katz Activities of Daily Living tool to assess an older adult's functional status. What question will the nurse include in this assessment?

Do you require any assistance when showering or bathing?

An older adult with a history of varicose veins presents with lower extremities that are reddish-brown and edematous. What is the nurse's best action?

Document findings and notify the healthcare provider

The nurse is assessing an elderly client and finds a suspicious lesion on the client's right forearm. The lesion is asymmetrical, has an irregular border, has color variation, and is approximately 8 mm in diameter. What is an appropriate nursing action for this client?

Document findings and refer the client for follow-up

Blood pressure abnormalities found more commonly in Western elderly include which of the following?

Elevation of the systolic BP

What is the most common reason for admission of the older adult to the emergency department (ED)?

Falls

Some symptoms are common in elderly clients. Which of the following is less likely to be a common problem in old age?

Fever.

An older client admits that she has recently begun wetting her pants. On further questioning by the nurse regarding the cause of the incontinence, the client explains, "I move so slowly these days that I can't always make it to a bathroom in time." The nurse recognizes this as which type of incontinence?

Functional

A nurse examines a frail elderly client's mouth and finds several broken and missing teeth and irritated gums. The nurse should assess this client closely for problems associated with which body system?

Gastrointestinal

A nurse examines a frail elderly client's mouth and finds several broken and missing teeth, and irritated gums. The nurse should assess this client closely for problems associated with which body system?

Gastrointestinal

Which strategy can the nurse use to effectively approach the older adult client during the health history?

Have the room well-lit with minimal background noise.

The Morse Fall Scale was developed for whom?

Hospitalized elders

The nurse is interviewing an 82-year-old client who is accompanied by her daughter. The daughter states that her mother is "unable to hold her urine," and the client attests that this is true. What question should the nurse prioritize when assessing the client's urinary incontinence?

Is this something that has begun to happen just recently?

Mr. Chin, 82 years old, comes to the office for a routine examination. The nurse notices a somewhat high-pitched murmur in the second right intercostal space during systole. It does not radiate, and the rest of his examination findings are within expected parameters for age. Which is true of the most likely cause of this murmur?

It carries with it increased risk for cardiovascular disease.

A nurse would like to assess an elderly client's general functional status in performing daily chores. Which of the following should the nurse implement to make this assessment?

Katz Activities of Daily Living tool

A nurse is working with an 88-year-old client who has developed stress incontinence. In this case, as in all cases, the nurse should understand that which of the following is the key to recognizing pathology and illness in the very old?

Knowing the person's baseline functional status and recognizing deviations from it

The nurse is assessing an older adult. Which assessment finding would the nurse recognize as a finding associated with aging?

Kyphosis

A nurse should assist an elderly client to assume which position to facilitate the examination of the anus and rectum?

Left side-lying

An elderly client states that the right eye has better eyesight than the left. A nurse recognizes that this may indicate the onset of what eye condition?

Macular degeneration

What information is it important for the nurse to remember when measuring a frail older adult client's height and weight?

Not allow the client to stand on a weight scale when measuring height

An older adult client has received a diagnosis of stress incontinence, and the nurse is planning the client's subsequent care. What health education is most relevant to this client's needs?

Pelvic floor strength training and activity management

While the nurse is interviewing a newly admitted older adult client, the client repeats the same story to the nurse several times. What is the nurse's next, best action?

Perform mini mental status exam

On receiving results of some lab work for a client, a nurse learns that the client has a platelet deficiency. Which skin condition related to this finding should the nurse look for in this client?

Petechiae

What is an appropriate modification in technique that a nurse should take for the examination of the frail elderly client?

Plan for additional time to allow as much independence as possible

A nurse is preparing a health education class for a group of older adult clients at a local senior center. The nurse is focusing on health promotion and disease prevention. Which condition would the nurse cite as a common cause of infection-related deaths in the elderly?

Pneumonia

A client is brought to the clinic by his daughter, who tells the nurse that she is concerned because her father appears to be losing weight and she doesn't know why. What would the nurse know is a cause of undernutrition?

Poverty

Mrs. Glynn is 90-years old and lives alone. She is able to bathe, dress, prepare her food, and transfer from bed to chair independently. She has children in the area who help her with her medications and transportation needs. Which of the following is considered an instrumental activity of daily living?

Preparing food

A nurse assesses a client's blood pressure and the findings suggest orthostatic hypotension. Which area should the nurse emphasize during client education?

Prevention of falls

The family members of an elderly client tell the nurse, "He has lost his appetite. He eats very small amounts, and only twice a day." Which suggestion would be most appropriate?

Recommend nutrient-dense foods.

When looking at a review of systems for an elderly client, which gastrointestinal data should cause the nurse the most concern?

Reports of constipation

When using the Romberg test of cerebellar function in an older client, which of the following findings is expected?

Slight sway with eyes closed

The nurse is counseling an elderly client and her family. Why would the nurse recommend regular aerobic exercise? (Select all that apply.)

Slow onset of disability Improve energy level Improve strength

In an interview with an elderly female client, the nurse learns that the client often has involuntary loss of urine when coughing, sneezing, or laughing. What type of incontinence should the nurse document in the client's record?

Stress

A 75-year-old female client tells the nurse that she is sexually active but that it causes her pain when she has intercourse. What would the nurse suggest to alleviate this pain?

Taking warm baths

A nurse is interviewing an elderly client and begins the interview by evaluating the client's mental status. The nurse does this based on an understanding of which of the following?

The aging brain is more easily affected by pathology.

An older adult client has been admitted for assessment related to decreased cognition. What assessment finding is most suggestive of delirium as the cause of the client's cognitive changes?

The client recently began a new medication regimen.

When assessing the skin, hair, and nails of the older adult, the nurse needs to know the normal effects of aging on these structures. Which of the following are normal effects of aging on the integumentary system? Select all that apply.

The epidermis thins Nails become thick and brittle with slow growth Wound healing slows as a result of decreased mitotic activity

The student nurse examines a 62-year-old client and reports to the preceptor that the client appears to have an infection in an untreated laceration on the calf. The student is unsure of the assessment because the client does not have a fever. The preceptor correctly explains that the older adult often does not have a fever with an infection.

True

In an interview with an elderly female client, the nurse learns that the client often has involuntary loss of urine associated with an abrupt and strong desire to void. What type of incontinence should the nurse document in the client's record?

Urge

Which intervention should the nurse suggest to a client to improve the condition of dry skin?

Use lanolin-based products

A nurse has assessed an elderly client and is preparing to analyze the assessment data. What would the nurse need in order to accurately perform data comparison?

Usual daily pattern

The nurse is reviewing an older adult's recent laboratory values prior to performing a physical assessment. What value would most clearly indicate the need for further nutritional assessment?

Vitamin B12 91 μg/ml

When inspecting the toenails of an elderly client, an expected finding is:

Yellowed, thickened, lusterless nails

A neurologic change associated with normal aging is

a decrease in reaction time.

The nurse detects a pulsation when assessing the abdomen of an older adult. Which condition does the nurse suspect the older adult has?

aortic aneurysm

A sign of infection in the elder that is more common than fever is

confusion.

An older adult client with type 2 diabetes reports leg pain. Which characteristic will assist the nurse in determining if this is persistent pain?

cramping legs for 3 months

The nurse familiar with the National Center for Health Statistics identifies which of the following as causes of adult mortality in people 65 years and older? (Select all that apply.)

diseases of the heart malignant neoplasms chronic lower respiratory diseases Alzheimer's disease

An older client demonstrates mental status changes after being diagnosed with a urinary tract infection. Which finding suggests that this client is experiencing delirium?

experiencing visual hallucinations

Common conditions or problems that accompany aging are often called

geriatric syndromes

The nurse wants to ensure that a thorough medication history has been completed with the older adult client. Which checks need to be included? Select all that apply.

medication name medication dose medication frequency client's understanding of the need for the medication

When assessing an older adult client, the nurse notes which age-related changes of the cardiovascular system that increase the risk for falls?

postural orthostatic hypotension

The nurse is performing a skin examination on a 68-year-old. The nurse notes raised, yellowish lesions that appear like warts and feel greasy. The nurse understands this is most likely

seborrheic keratoses

The nurse observes a dark brown, pigmented waxy lesion 2-mm in size on the right forearm of an older adult. The nurse recognizes this lesion as:

seborrheic keratosis

A key area to assess in older adults with chronic respiratory or cardiac problems and some constant degree of dyspnea is

the degree to which dyspnea affects daily function.

Any new onset of incontinence in the frail elder should be investigated for

urinary tract infection.

Which finding noted during assessment of the oral cavity of an older adult alerts the nurse that the older adult may be neglecting oral care?

white patchy plaque on the tongue