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27 Cards in this Set
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A nurse is caring for an older adult client who has pneumonia. Which of the following physiologic changes associated with aging places the client at a greater risk for pneumonia? |
a. Decreased anterior-posterior diameter b. Increased diameter of the small airways c. Decreased number of cilia d. Increased alveolar surface area
Answer
a. Decreased anterior-posterior diameter A physiologic change associated with aging is a calcification of the bronchial and costal (rib) cartilage and diminished chest wall compliance, leading to an increase in the anterior-posterior diameter. The resultant reduced total lung capacity puts the client at increased risk for hypoxemia. b. Increased diameter of the small airways A physiologic change associated with aging is a decreased diameter of the small airways. However, the diameter of the large airways does increase with age, and these two factors combined can lead to an increase in dead space, gas trapping, and ventilation-perfusion imbalance. c. Decreased number of cilia CORRECT. A physiologic change associated with aging is a decreased number of cilia. This, along with a less effective cough, leads to diminished efficiency of the normal defense mechanisms for clearing the airway, putting the client at increased risk for infection, such as pneumonia. d. Increased alveolar surface area A physiologic change associated with aging is an increase in the size of the alveolar ducts and respiratory bronchioles, leading to a decrease in the alveolar surface area. Consequently, there is less surface area for gas exchange to occur, putting the client at an increased risk for hypoxemia. |
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A nurse is contributing to the plan of care for a client who had a recent stroke and a history of gastroesophageal reflux disease (GERD). For which of the following disorders should the nurse plan to monitor this client? |
a.Duodenal ulcer disease
b.Aspiration pneumonia
c. Viral pneumonia
d. Esophageal varices
Answer
a. Duodenal ulcer disease The acidity of stomach contents that reflux back into the esophagus results in an inflamed esophagus, not duodenum, which is a section of the small intestine. With duodenal ulcer disease, there are ulcers in the duodenum, usually associated with stress, COPD, pancreatic disease, and chronic renal failure. b. Aspiration pneumonia
CORRECT. GERD results in reflux of gastric secretions from the stomach into the lower esophagus. When regurgitation occurs, the client is at high risk for pneumonia. Pneumonia occurs due to aspiration of gastric contents into the airway. This client is at increased risk for dysphagia due to the stroke and history of GERD, so the nurse should monitor closely for aspiration pneumonia. c. Viral pneumonia The cause of viral pneumonia is an inhaled virus that settles in the lungs. GERD does not increase the risk of viral pneumonia. d. Esophageal varices Esophageal varices occur in clients who have portal hypertension, usually due to hepatic cirrhosis. |
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A nurse is caring for an older adult client. Which of the following physiologic changes associated with aging can affect medication dosage in this client? |
a. Increased glomerular filtration rate
b. Decreased body fat
c. Decreased gastric motility
d. Decreased gastric pH
Answer
a. Increased glomerular filtration rate The aging process results in a decreased glomerular filtration rate and causes the medications to filter at a slower rate; therefore, medications remain in the body longer. b. Decreased body fat Body fat increases with aging. Medications that are stored in adipose tissue will have an increased tissue concentration, decreased plasma concentration, and a longer duration in the body. c. Decreased gastric motility Decreased gastric motility results in medications remaining in the digestive tract for longer periods of time, leading to slow absorption of the medication. The provider might have to allow for a longer time for medication onset and peak by extending the length of time between doses. d. Decreased gastric pH With aging, gastric pH increases, becoming more alkaline. The nurse should avoid giving preparations that neutralize gastric secretions if a low gastric pH is required for medication absorption. |
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A nurse is reviewing the medical record of a client who is postmenopausal and has osteoporosis. The client has a new prescription for alendronate sodium. Which of the following findings in the client’s history should the nurse recognize is a contraindication to this medication? |
a. Glaucoma b. Paget’s disease c. Esophageal stricture d. Long-term corticosteroid use
Answer
a. Glaucoma Glaucoma is a degenerative eye disease where increased intraocular pressure causes damage to the optic nerve. It is not a contraindication to the use of alendronate sodium. b. Paget’s disease Paget’s disease is a metabolic bone disease that involves bone destruction and regrowth that results in deformity. Medical treatment with a bisphosphonate, such as alendronate sodium, is considered first-line therapy. c. Esophageal stricture
CORRECT. Clients who have a history of esophageal abnormalities, such as stricture or achalasia, have delayed esophageal emptying, which greatly increases the client’s risk for esophageal erosion, bleeding, and perforation. Alendronate sodium is a bisphosphonate, which prevents or slows weakening of bone. It is used to prevent and treat postmenopausal osteoporosis. The nurse should instruct the client to wait at least 30 min after taking alendronate sodium before eating, drinking, or taking other medications, and caution her not to lie down for at least 30 min after taking the medication. Standing or sitting upright ensures that the client gets the full dose and decreases heartburn or the risk of injury to the esophagus. d. Long-term corticosteroid use Long-term steroid use is frequently associated with the development of osteoporosis, and treatment with a bisphosphonate is considered first-line therapy. Alendronate sodium is a bisphosphonate, which prevents or slows weakening of bone. It is used to prevent and treat postmenopausal osteoporosis and Paget’s disease. |
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A nurse is assisting with the admission of an older adult client who fell at home 3 days ago. The client has a fractured hip, malnutrition, and dehydration. Which of the following laboratory values, noted on admission, should indicate to the nurse prolonged malnutrition? |
a. Increased sodium b. Decreased albumin c. Increased BUN d. Decreased blood glucose
Answer
a. Increased sodium Increased sodium is indicative of dehydration, which is due to a fluid volume deficit. b. Decreased albumin CORRECT. Decreased albumin is indicative of inadequate protein intake, which is a common finding in a client who has prolonged malnutrition. c. Increased BUN Increased BUN is indicative of renal failure, or dehydration, which is due to a fluid volume deficit. d. Decreased blood glucose Decreased blood glucose is indicative of inadequate intake of glucose, which is a manifestation that can occur rapidly in any client who has not eaten in several days. It is not indicative of prolonged malnutrition. |
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A nurse is participating on a committee that is developing age-appropriate care standards for older adult clients. Which of the following of Erikson’s developmental tasks should the nurse recommend as the focus? |
a.Intimacy
b. Identity
c. Integrity
d. Initiative
Answer
a. Intimacy
Intimacy vs. isolation is the conflict that clients must resolve during young adulthood. In this stage, clients develop love relationships and the capacity for intimacy.
b. Identity
Identity vs. role confusion is the conflict that clients must resolve during adolescence. This is the time when clients ask the question "Who am I?" To answer this question successfully, Erikson suggests that adolescent clients must integrate healthy resolutions from all earlier conflicts.
c. Integrity
CORRECT. Integrity vs. despair is the conflict that older adult clients must resolve when they reflect on their lives and their roles. If the client has achieved a sense of unity and fulfillment about life, she will accept death with a sense of integrity, not fear.
d. Initiative
Initiative vs. guilt is the conflict that clients must resolve during early childhood. In this stage, children must learn to achieve a balance between eagerness for more adventure and taking on more responsibility, learning to control impulses and childish fantasies. |
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A nurse is contributing to the plan of care for a client who had a stroke. Which of the following goals should the nurse identify as the priority for this client? |
a. The client's skin will remain intact during hospitalization. b. The client will verbalize one new word each week. c. The client will begin to help turn himself in bed, indicating improved mobility. d. The client's airway will remain clear, as evidenced by clear breath sounds.
Answer
a. The client's skin will remain intact during hospitalization. Prevention of skin breakdown following a stroke is an important goal; however, there is another goal that is the priority. b. The client will verbalize one new word each week. Relearning speech is important for communication skills following a stroke; however, there is another goal that is the priority. c. The client will begin to help turn himself in bed, indicating improved mobility. Following a stroke, one goal of rehabilitation is to encourage self-help. Activity goals are important; however, there is another goal that is the priority. d. The client's airway will remain clear, as evidenced by clear breath sounds. CORRECT. The nurse should apply the ABC priority-setting framework when caring for this client. This framework emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life and is the nurse’s priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. The priority nursing action is to promote pulmonary hygiene as evidenced by clear breath sounds. |
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A nurse is caring for an older adult client who has a new onset of type 2 diabetes mellitus. Which of the following physiologic changes contribute to the development of type 2 diabetes? |
a. Increased production of insulin by the pancreas b. Decreased sensitivity to the circulating insulin c. Increased rate of glucose metabolism d. Decreased release of glycogen by the liver Answer a. Increased production of insulin by the pancreas There is an insufficient release of insulin by the beta cells within the pancreas with type 2 diabetes mellitus. b. Decreased sensitivity to the circulating insulin CORRECT. The pancreas in older adult clients demonstrates reduced tissue sensitivity to circulating insulin, leading to an increased risk of developing type 2 diabetes mellitus. c. Increased rate of glucose metabolism There is a decrease in the rate of glucose metabolism in older adult clients. This is especially true if there is a sudden, high concentration of glucose consumed. d. Decreased release of glycogen by the liver Glucose is stored in the liver as glycogen. A decrease in the amount of glycogen converted to glucose and released to the body results in a decrease in blood glucose, rather than an elevation. |
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A nurse at a long-term care facility is assisting with planning care for a group of older adult clients. When planning care, the nurse should consider that older adult clients are most likely to exhibit a decrease in which of the following? |
a. Short-term memory b. Creative ability c. Decision-making skills d. Cognitive capacity Answer a. Short-term memory CORRECT. The ability to process short-term memories decreases as part of the aging process. As a result, older adult clients might require reminders regarding their medications, ADLs, or daily schedules. The nurse should recognize that residents might have difficulty remembering their names from day to day, ask the same question repeatedly, or need assistance remembering recent events. b. Creative ability Creative ability does not decrease in older adult clients. Most long-term care facilities provide recreational activities, including opportunities for creating things through artistic expression, for clients. Clients who have dementia and other neurologic disorders might still be able to participate in creative activities. c. Decision-making skills Decision-making skills do not decrease in older adult clients as a result of the aging process. Clients who have dementia and neurologic disorders might still be able to participate in making decisions about themselves or their care. Unless the client is found to be incompetent, the client will retain decision-making rights, including self-determination and autonomy. d. Cognitive capacity Cognition does not decrease in older adult clients as a result of the aging process. Clients who have dementia and other organic or traumatic brain disorders might still be able to learn simple tasks or adjust to new situations or routines. The client's speed, rather than ability, to complete a task might decrease. |
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A nurse in a long-term care facility is promoting reminiscence among older adult clients. Which of the following actions should the nurse take? |
a. Establish a weekly pet therapy visitation program. b. Place a calendar and clock in each resident’s room. c. Institute a daily storytelling hour. d. Encourage all clients to eat their meals in the dining room. Answer a. Establish a weekly pet therapy visitation program. Pet therapy visitation programs can be beneficial in promoting socialization and social skills for clients, but it does not promote reminiscence. b. Place a calendar and clock in each resident’s room. Placing a calendar and clock in each client’s room will promote the client’s level of orientation to date and time, but it will not promote reminiscence. c. Institute a daily storytelling hour. CORRECT. A storytelling hour is an example of reminiscence therapy, which allows clients to share stories of their past and reminisce with others who might have similar or shared memories. According to Erikson’s psychosocial theory, reminiscence is an important action for older adult clients. d. Encourage all clients to eat their meals in the dining room. Having clients eat their meals in a group dining room is beneficial to promoting socialization, but it will not promote reminiscence. |
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A nurse is reinforcing dietary teaching with an older adult client who is on bedrest following development of deep vein thrombosis (DVT) about methods to increase peristalsis. Which of the following high-fiber food choices should the nurse recommend? |
a. Navy bean soup b. Canned fruit juice c. White rice pudding d. Soy milk
Answer
a. Navy bean soup CORRECT. An older adult client who is on bedrest has an increased risk for constipation due to the decreased peristalsis associated with the aging process. Increasing dietary fiber by adding foods like legumes to the diet, as well as ensuring adequate fluid intake, will promote bowel regularity. b. Canned fruit juice The nurse should recommend canned fruit and fruit juices without pulp as a low-fiber choice, which can help decrease peristalsis. c. White rice pudding The nurse should recommend rice pudding as a low-fiber choice, which can help decrease peristalsis. d. Soy milk The nurse should recommend soy milk as a low-fiber choice, which can help decrease peristalsis. |
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A nurse is planning to administer diphenhydramine hydrochloride to an older adult client. Which of the following actions should the nurse plan to take prior to administration? |
a. Review the medical record for a client history of glaucoma. b. Plan to administer the medication 30 min prior to a meal. c. Explain to the client he will need to restrict his fluid intake once he takes the medication. d.Remind the client that his appetite might increase when starting the medication.
Answer
a. Review the medical record for a client history of glaucoma.
CORRECT. The nurse should review the medical record for a history of glaucoma prior to administration of the medication. Diphenhydramine is contraindicated for clients who have narrow-angle glaucoma. b. Plan to administer the medication 30 min prior to a meal. The nurse should administer diphenhydramine with food or milk to decrease gastrointestinal adverse effects. c. Explain to the client he will need to restrict his fluid intake once he takes the medication. The nurse should plan to inform the client to increase fluid intake. This medication has an atropine-like drying effect and thickens bronchial secretions. d. Remind the client that his appetite might increase when starting the medication. The nurse should remind the client that anorexia, nausea, and vomiting are gastrointestinal adverse effects of the medication. |
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A nurse is collecting data from an older adult client who states he is homeless. Which of the following findings should the nurse document as comorbidities for this client? |
a. Inadequate shelter and clothing for the weather Inadequate shelter and clothing for the weather are risk factors for disease but are not comorbidities. b. Malnutrition and poverty Malnutrition can be both a risk factor for disease and a symptom of disease, and poverty is a risk factor. However, these are not comorbidities. c. Dementia and tuberculosis The term comorbidity refers to medical conditions known to co-exist in a client. The number of comorbid conditions present in a client is used to provide an indication of his health status and risk of death. Dementia and tuberculosis occurring in an individual client is an example of comorbidity and increases the client’s risk. d. Lack of preventive health care and immunizations Lack of preventive health care and immunizations are risk factors for disease, but are not comorbidities. |
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A nurse is collecting data from an older adult client. Which of the following actions should the nurse take to collect subjective data? |
a. Leave the client a written questionnaire to fill out in private. b. Allow sufficient time for the client to respond to the questions. c. Talk to family members to obtain the client’s health history. d. Obtain the health history from the client’s medical record.
Answer
a. Leave the client a written questionnaire to fill out in private. The nurse should obtain subjective data by asking the client questions and having the client provide verbal descriptions of her health problems. b. Allow sufficient time for the client to respond to the questions. CORRECT. The nurse should recognize that it might take an older adult client longer than other clients to process and respond to questions. Consequently, the nurse should allow adequate time for the client to respond without appearing rushed. The client’s verbal responses formulate the subjective data of the health history. c. Talk to family members to obtain the client’s health history. Family members can serve as a source of information for the nurse and they can confirm findings that a client provides. However, only the client can provide subjective data relevant to her health condition. d. Obtain the health history from the client’s medical record. The client's medical record is a source for her medical history, laboratory and diagnostic test results, and current physical findings. However, only the client can provide subjective data relevant to her condition. |
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A nurse at an assisted living center is conducting an orientation session for a group of newly hired assistive personnel (AP). Which of the following instructions should the nurse include regarding clients who are hearing impaired? |
a. Maintain eye contact with the clients. b. Stand to one side of the clients and speak into their good ears. c. Speak loudly with exaggerated enunciation. d. Ask only questions with yes or no answers.
Answer
a. Maintain eye contact with the clients. Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. Maintaining eye contact will help to promote lip-reading. b. Stand to one side of the clients and speak into their good ears. Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. Speaking while standing to one side of the client will not give him the ability to use lip-reading or see gestures. c. Speak loudly with exaggerated enunciation. Many older adult clients who are hearing impaired use lip-reading and gestures to help understand what is said to them. The client can hear better when the nurse speaks in a moderate tone of voice. d. Ask only questions with yes or no answers. This is not a helpful action. To respond, even with just a yes or no, the client must be able to hear or understand what is said to him. |
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A nurse is reinforcing teaching with a newly hired assistive personnel about her role in helping older adult clients with activities of daily living (ADLs). The nurse should explain that which of the following is the most common factor that affects a client's ability to perform ADLs? |
a. Social withdrawal b. Chronic physical disability c. Emotional impairment d. Cognitive dysfunction
Answer
a. Social withdrawal Although some older adult clients might become socially withdrawn due to depression, physical debilitation, or lack of transportation, it should not affect their ability to perform ADLs. b. Chronic physical disability CORRECT. Physical disability is the most common reason older adult clients have difficulty performing ADLs. Self-care deficit, the nursing diagnosis that describes the inability of the client to perform self-care activities necessary for optimum health and function, is associated with several physical etiologic factors: activity intolerance, pain, neuromuscular impairment, sensory-perceptual impairment, musculoskeletal impairment, and cognitive impairment. c. Emotional impairment Emotional stability does not decrease in older adult clients as a consequence of the aging process. While depression is common in older adult clients, it is often associated with a serious or disabling medical diagnosis, physical impairment, or as a side effect of medications. Clients who are depressed might, as a result of their mood disorder, be reluctant to perform their ADLs and need assistance or encouragement. d. Cognitive dysfunction Cognition does not decrease in older adults as a consequence of the aging process. Even clients who have dementia and other neurologic disorders might still be able to learn and perform tasks, such as ADLs, or adjust to new situations or routines. |
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A nurse is reinforcing teaching with a group of healthy older adult clients about health screenings after age 50 years. Which of the following health screenings should the nurse recommend that the clients complete annually? |
a. Cholesterol b. Colonoscopy c. Diabetes mellitus d. Visual acuity
Answer
a. Cholesterol The nurse should recommend cholesterol screening every 3 to 5 years until age 75 years. b. Colonoscopy While an annual rectal exam, including a stool specimen for occult blood, is a current recommendation, the recommendation for a colonoscopy is every 5 to 10 years beginning at the age of 50 years. c. Diabetes mellitus The nurse should recommend that older adult clients have a diabetes mellitus screening performed every 3 years, unless the client is high risk, and then the nurse should recommend more frequent screenings. d. Visual acuity CORRECT The nurse should recommend an annual visual acuity screening for all clients over 50 years of age. |
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A nurse is collecting data from an older adult client for signs of dehydration. Which of the following findings should the nurse consider an expected part of the aging process? |
a. Elevation of urine specific gravity b. Decreased creatinine clearance c. Dry oral mucous membranes d. Poor skin turgor over the sternum
Answer
a. Elevation of urine specific gravity Elevation of urine specific gravity is an unexpected finding that could be indicative of dehydration. Normal specific gravity should range from approximately 1.010 to 1.020. Results obtained below this range indicate dilute urine, associated with overhydration and some medical conditions, such as poorly controlled diabetes insipidus. Results obtained above this range indicate concentrated urine, associated with dehydration and some medical conditions, such as poorly controlled diabetes mellitus. b. Decreased creatinine clearance
CORRECT. Creatinine clearance declines with age and, therefore, the kidneys have a decreased ability to concentrate urine. This expected part of the aging process places the client at risk for dehydration. c. Dry oral mucous membranes Dry oral mucous membranes is an unexpected finding that could be indicative of dehydration. Other causes of dry mucous membranes include side effects of medications, such as decongestants, diuretics, antihypertensives, antidepressants, and antihistamines; radiation therapy; or certain medical conditions, such as Parkinson’s disease. d. Poor skin turgor over the sternum Poor skin turgor over the sternum is an unexpected finding that could be indicative of dehydration. Skin turgor is an abnormality in the skin’s ability to change shape and return to normal. Decreased skin turgor is a late sign of dehydration. It is associated with moderate to severe dehydration. Fluid loss of 5% of the body weight is considered mild dehydration, 10% is moderate, and 15% or more is severe dehydration. |
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A nurse is reinforcing discharge teaching about calcium supplements with an older adult female client who has osteoporosis and a recent repair of a fracture in her right hip. Which of the following instructions should the nurse include? |
a. "You should take your calcium supplement with a large glass of water." b. "You should increase your intake of grain cereals while taking calcium supplements." c. "You should take at least 2600 milligrams of calcium supplements daily." d. "You will not need to take vitamin D with your calcium supplement because you are postmenopausal."
Answer
a. "You should take your calcium supplement with a large glass of water."
CORRECT. The nurse should instruct the client to take calcium supplements with a large glass of water, with or after meals, to promote absorption of the supplement. b. "You should increase your intake of grain cereals while taking calcium supplements." Foods such as oatmeal and other grain cereals contain phytic acid, which can decrease the absorption of calcium supplements. c. "You should take at least 2600 milligrams of calcium supplements daily." The recommended dietary allowance (RDA) of calcium for the older adult female client is 1200 mg. Supplements are taken to make up the difference between what the diet provides and the RDA. There is a risk of calcium toxicity if intake exceeds the RDA. d. "You will not need to take vitamin D with your calcium supplement because you are postmenopausal." The recommendation is for clients who are taking a calcium supplement to also take vitamin D to increase absorption, even after menopause. |
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A nurse is assisting with the care of an older adult client who has dementia. The client becomes agitated and confused at night and wanders into the hallway. Which of the following actions should the nurse take? |
a. Place the client’s mattress on the floor. b. Restrain the client during the nighttime hours. c. Provide continuous orientation to the client. d. Turn out the lights in the client’s room at night.
Answer
a. Place the client’s mattress on the floor.
CCORRECT. To ensure the client’s safety and prevent falls when he is confused at night, the nurse should place his mattress on the floor. b. Restrain the client during the nighttime hours. The nurse should choose a sensor device to alarm when the client is wandering. Restraints can cause the client to become frightened and struggle against them. c. Provide continuous orientation to the client. The nurse should provide orientation information only if it calms the client. When the client is agitated, the nurse should not try to force orientation and further increase his distress. d. Turn out the lights in the client’s room at night. The nurse should keep the area well lit because lighting can reinforce orientation for the client and minimize illusions. |
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A nurse at an ophthalmology clinic is collecting data from a client referred by the provider for a potential cataract. Which of the following client reports should the nurse recognize is consistent with cataracts? |
a.Halos when looking at lights b. Loss of peripheral vision c. Bright flashes of light and floaters d. Eyestrain and headache with close work
Answer
a. Halos when looking at lights
CORRECT. A cataract is a cloudy or opaque area in the lens of the client's eye. Cataracts in adults usually develop with advancing age and can be hereditary. Cataracts develop slowly and painlessly with a gradual onset of difficulty with vision. Visual problems include difficulty seeing at night, halos around lights or glare sensitivity, and decreased visual acuity, even in daylight. Cataracts are accelerated by environmental factors, such as cigarette smoke or other toxic substances, or in response to metabolic diseases, such as diabetes mellitus. b. Loss of peripheral vision Loss of peripheral vision is an initial report by a client who has open-angle glaucoma. Glaucoma is a condition characterized by increased fluid pressure inside the eye, known as intraocular pressure. This increased pressure damages the optic nerve, causing partial vision loss, with blindness as a possible outcome. c. Bright flashes of light and floaters Bright flashes of light, especially in the peripheral visual field, and floaters are associated with retinal detachment. Retinal detachment refers to the separation of the light-sensitive membrane in the back of the eye from its supporting layers. Trauma, the aging process, severe diabetes mellitus, or an inflammatory disorder can cause retinal detachment, but it frequently occurs spontaneously. d. Eyestrain and headache with close work Eyestrain and headache with close work is associated with decreased visual acuity. Both nearsightedness, which is an error of visual focusing that makes distant objects appear blurred, and farsightedness, which is an age-associated progressive loss of the focusing power of the lens that results in difficulty seeing objects close-up, can cause eyestrain and headache. Changes in visual acuity can represent primary eye disease, aging, eye trauma, or a generalized, systemic illness, but whatever the cause, the nurse should not ignore visual changes Decreased vision is a significant threat |
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A nurse in the clinic is assessing an older adult client for the second time this week. The client reports a decreased energy level, insomnia, and anorexia. Diagnostic tests are within the expected reference ranges. For which of the following conditions should the nurse screen the client? |
a. Sarcopenia b. Dementia c. Depression d. Diabetes
Answer
a. Sarcopenia Sarcopenia is an impairment of muscle tone. The loss of muscle tone is caused by physical inactivity, a change in the central and peripheral nervous systems, and reduced skeletal protein synthesis. b. Dementia Dementia refers to a group of symptoms involving progressive impairment of all aspects of brain function. Most of the disorders associated with dementia are irreversible, degenerative conditions. c. Depression CORRECT. Depression, an altered mood state characterized by decreased energy levels, insomnia, anorexia, and sadness, is a common condition among older adult clients. Depression can be a response to an acute or chronic illness. Depression in older adult clients can also be the result of medications such as analgesics, antihypertensives, steroids, and cardiovascular agents. d. Diabetes The presenting manifestations of diabetes mellitus, a condition caused by the inability of the pancreas to secrete enough insulin for carbohydrate metabolism, include polydipsia, polyuria, and polyphagia. Polyuria is also a manifestation of diabetes insipidus, which is a condition caused by the inability of the kidneys to conserve water. |
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A nurse is reinforcing teaching with a group of older adult female clients who are postmenopausal about dietary requirements. Which of the following statements about the role of folic acid should the nurse make? |
a. "Clients who are postmenopausal need to limit their intake of folic acid to reduce their risk of stroke." b. "Dietary folic acid is not of significant importance after the childbearing years." c. "Healthy clients who are postmenopausal require a daily folic acid supplement." d. "Adequate folic acid intake is associated with a reduced risk for heart disease."
Answer
a. "Clients who are postmenopausal need to limit their intake of folic acid to reduce their risk of stroke."
Clients who are postmenopausal and consume the recommended daily intake of 400 mcg of folic acid have significantly lower levels of homocysteine, a risk factor for heart disease, than those who do not.
b. "Dietary folic acid is not of significant importance after the childbearing years."
Folic acid has a role in the prevention of birth defects. However, recent studies suggest that clients who are postmenopausal can reduce their risk of heart disease with a diet rich in folic acid.
c. "Healthy clients who are postmenopausal require a daily folic acid supplement."
Recent studies have shown that most clients who are postmenopausal need to increase their daily intake of folic acid; however, a supplement is unnecessary to accomplish this. The client can consume adequate amounts of folic acid by increasing daily intake of foods such as orange juice, beans, legumes, and green leafy vegetables, as well as foods enriched with folic acid, such as breads and pastas.
d. "Adequate folic acid intake is associated with a reduced risk for heart disease."
CORRECT. Clients who are postmenopausal and consume the recommended daily intake of 400 mcg of folic acid have significantly lower levels of homocysteine, a risk factor for heart disease, than those who do not. Older adult female clients need to improve their daily folic acid intake, which can be accomplished by increasing daily dietary intake of foods such as orange juice, beans, legumes, and green leafy vegetables, as well as foods enriched with folic acid, such as breads and pastas. |
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A nurse is reinforcing teaching with an older adult client who has anemia. Which of the following foods should the nurse recommend to increase the client’s iron intake? |
a. Greek yogurt b. Bran muffin c. Peanut butter sandwich d. Dried fruit
Answer
a. Greek yogurt The nurse should recommend yogurt to increase the client’s intake of zinc and calcium. b. Bran muffin The nurse should recommend bran muffins to increase the client’s intake of fiber. c. Peanut butter sandwich The nurse should recommend a peanut butter sandwich to increase the client’s intake of a complementary protein, which is when two incomplete proteins are together, making the sandwich a complete protein d. Dried fruit The nurse should recommend the client eat more dried fruit to increase iron in the diet. |
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A nurse is assisting with planning care for an older adult client following abdominal surgery for a bowel obstruction. Which of the following information about pain management should the nurse include in the plan of care? |
a. Older adult clients have a diminished capacity to perceive pain. b. Older adult clients should not take narcotics for pain control. c. Older adult clients have increased pain as a normal part of aging. d. Older adult clients are sensitive to the analgesic effect of opiates.
Answer
a.Older adult clients have a diminished capacity to perceive pain. Older adults do not have a diminished capacity to perceive pain. However, older adult clients might have developed excellent coping skills that make it difficult to observe for cues of pain. b. Older adult clients should not take narcotics for pain control. The nurse can administer narcotic medications safely to older adult clients. Although older adult clients might be more sensitive to narcotics, it does not justify withholding narcotic medication for pain control. c. Older adult clients have increased pain as a normal part of aging. Pain is not an expected finding of the aging process. The nurse should assess, diagnose, and manage pain in older adult clients similar to any other client, regardless of age. d. Older adult clients are sensitive to the analgesic effect of opiates. An older adult client is likely to require a decreased dose of opiates to provide the same level of analgesia as a younger client, with a reduced risk of side effects, because he metabolizes opiates more slowly. |
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A nurse is collecting data from an older adult client during an annual physical. Which of the following findings should the nurse report to the provider? |
a. BP 118/76 mm Hg b. Fasting blood glucose level 160 mg/dL c. Report of waking to void two to three times per night d. Report of a bowel movement every other day
Answer
a. BP 118/76 mm Hg
b. Fasting blood glucose level 160 mg/dL
c. Report of waking to void two to three times per night
d. Report of a bowel movement every other day
Answer
a. BP 118/76 mm Hg
The client's BP is within the expected reference range for an older adult client. The nurse should inform the provider if the client’s BP is equal to or greater than 140/90 mm HG. The nurse should counsel the client to continue to have his BP checked at regular intervals. b. Fasting blood glucose level 160 mg/dL
CORRECT. The nurse should recognize that a fasting blood glucose level of 160 mg/dL is elevated. The nurse should report this value to the provider for further evaluation, as the client might be showing early signs of diabetes mellitus.
c. Report of waking to void two to three times per night
Waking to void at night can be due to the normal aging process. Bladder capacity decreases with age, causing the client to reach a sensation of fullness and the need to void several times during the night.
d. Report of a bowel movement every other day
The client who evacuates the bowels every other day might be due to slowing of peristalsis, which is a part of the aging process. The nurse should counsel the client on the benefits of adequate fluid and fiber in the diet to maintain bowel regularity. |
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An older adult client tells a nurse at a health fair "I am always forgetting things. I cannot even remember where I parked my car! Do you think I have Alzheimer’s disease?" Which of the following is a therapeutic response by the nurse? |
a. "Maybe. Perhaps you should discuss your concerns with your doctor." b. "I am forgetful too. I can’t remember where I parked my car either!" c. "You're probably just having 'senior moments.' Everyone has memory lapses." d. "That must be very upsetting. Can you tell me about your forgetfulness?"
Answer
a. "Maybe. Perhaps you should discuss your concerns with your doctor." This statement is an example of the nontherapeutic communication technique of rejecting. The nurse refuses to discuss the topic with the client and can make the client feel as though the nurse is rejecting her as well. b. "I am forgetful too. I can’t remember where I parked my car either!" This statement is an example of the nontherapeutic communication technique of changing topics and subjects. This can block further communication with the client. c. "You're probably just having 'senior moments.' Everyone has memory lapses." This statement is an example of the nontherapeutic communication technique of unwarranted reassurance by replying with a cliché. This can block the thoughts of the client. d. "That must be very upsetting. Can you tell me about your forgetfulness?"
CORRECT. This statement is an example of the therapeutic communication technique of empathy and clarification. The client has stated a problem with forgetfulness, so the nurse empathizes with the client’s concern and seeks additional information with which to counsel the client. |
