Chapter 14: Older Adults Review Questions

Question 1

A student nurse is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient’s temperature was 37.1° C (98.8° F). The student reports her recent assessment to the registered nurse (RN): the patient’s temperature is 37.2° C (99° F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend first?

1. Tell the student that temporary confusion is normal and simply requires reorientation
2. Tell the student to increase the patient’s fluid intake since the urine is concentrated
3. Tell the student that her assessment findings are normal for an older adult
4. Tell the student that he will notify the physician of the findings

Answer 1

Answer: 4.
The patient may have subtle symptoms of a urinary tract infection, as evidenced by a slight increase in body temperature, development of confusion, and the dark-colored urine. Temporary confusion is not a normal condition in older adults. Increasing the fluid intake is acceptable but not a recommendation for the set of symptoms the patient presents. The presenting set of symptoms is not normal.

Question 2

A patient’s family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.) 1. The center should be clean, and rooms should look like a hospital room.

2. There should be adequate staffing on all shifts.
3. Social activities should be available for all residents.
4. Three meals should be served daily with a set menu and serving schedule.
5. Family involvement in care planning and assisting with physical care is necessary.

Answer 2

Answer: 2, 3, 5.
Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat and when it is served. A nursing center should be clean, but it should look like a person’s home.

Question 3

A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing:

1. Dementia.
2. Depression.
3. Delirium.
4. Disengagement.

Answer 3

Answer: 2.
Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation.

Question 4

A major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis could precipitate:

1. Dementia.
2. Delirium.
3. Depression.
4. Stroke.

Answer 4

Answer: 3.
The onset of depression could be abrupt or gradual, but the usual cause is a major life-altering event in the life of the person experiencing the depression.

Question 5

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult?

1. When the sexual partner passes away, the survivor no longer feels sexual.
2. A decrease in an older adult’s libido occurs.
3. Any outward expression of sexuality suggests that the older adult is having a developmental problem.
4. All older adults, whether healthy or frail, need to express sexual feelings.

Answer 5

Answer: 4.

Sexuality is normal throughout the life span, and older adults need to be able to express their sexual feelings.

Question 6

Older adults experience a change in sexual activity. Which best explains this change?

1. The need to touch and be touched is decreased.
2. The sexual preferences of older adults are not as diverse.
3. Physical changes usually do not affect sexual functioning.
4. Frequency and opportunities for sexual activity may decline.

Answer 6

Answer: 4.
As a result of loss of a loved one or a chronic illness in themselves or their partner, opportunities for sexual activity may decline.

Question 7

You see a 76-year-old woman in the outpatient clinic. Her chief complaint is vision. She states she has really noticed glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. You suspect that she may have:

1. Presbyopia.
2. Disengagement.
3. Cataract(s).
4. Depression.

Answer 7

Answer: 3.
Cataracts normally result in blurred vision, sensitivity to glare, and gradual loss of vision. Presbyopia is a common eye condition resulting in a person having difficulty adjusting to near and far vision. The symptoms are not reflective of depression since her vision affects her ability to interact. She has not chosen to avoid her friends. Disengagement is a term referring to aging theory.

Question 8

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before dis- charge. What can you do to facilitate the patient’s understanding of his discharge instructions? (Select all that apply.)

1. Speak loudly so the patient can hear you.
2. Sit facing the patient so he is able to watch your lip movements and facial expressions.
3. Present one idea or concept at a time.
4. Send a written copy of the instructions home with him and tell him to have the family review them.
5. Include the family caregiver in the teaching session

Answer 8

Answer: 2, 3, 5.
Teaching and communication are more effective with older adults when you sit and face the patient and present one idea or concept at a time. This requires planning. Speaking loudly can distort sound. Speak in a normal tone. Sending instructions is helpful but will not directly facilitate the patient’s own understanding. Sharing information with a caregiver provides someone to clarify instructions.

Question 9

Taste buds atrophy and lose sensitivity, and appetite may decrease. As a result, the older adult is less able to discern:

1. Spicy and bland foods.
2. Salty, sour, and bitter tastes.
3. Hot and cold food temperatures.
4. Moist and dry food preparations.

Answer 9

Answer: 2.

Often an older adult uses “heavy” spices because of his or her inability to taste the food.

Question 10

Kyphosis, a change in the musculoskeletal system, leads to:

1. Decreased bone density in the vertebrae and hips.
2. Increased risk for pathological stress fractures in the hips.
3. Changes in the configuration of the spine that affect the lungs and thorax
4. Calcification of the bony tissues of the long bones such as in the legs and arm.

Answer 10

Answer: 3.

This can also affect the ability of the patient to deep breath and cough effectively.

Question 11

A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are your major concerns for this patient? (Select all that apply.)

1. The loss of his work role
2. The risk of social isolation
3. A determination if the wife will need to start working
4. How the wife expects household tasks to be divided in the home in retirement
5. The age the patient chose to retire

Answer 11

Answer: 1, 4.
The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time, nor is the age of the patient.

Question 12

During a home health visit a nurse talks with a patient and his family caregiver about the patient’s medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? (Select all that apply.)

1. Taking two medications for hypertension
2. Taking a total of eight different medications during the day.
3. Having one physician who reviews all medications
4. Patient’s health history
5. Involvement of the caregiver in assisting with medication administration

Answer 12

Answer: 2, 4.
The patient is at risk for an adverse drug event (ADE) because of polypharmacy and his history of renal disease, which affects drug excretion. Taking two medications for hypertension is common. Having one physician review all medications and involving a family caregiver are desirable and are safety factors for preventing ADEs.

Question 13

You are caring for an 80-year-old man who recently lost his wife. He shares with you that he has been drinking more than he ever did in the past and feels hopeless without his wife. He reports that he rarely sees his children and feels isolated and alone. This patient is at risk for:

1. Dementia.
2. Liver failure.
3. Dehydration.
4. Suicide.

Answer 13

Answer: 4.
The patient is sharing that he is depressed. Key concepts include recent loss of his wife, excessive drinking, hopelessness, and isolation, making him at risk for suicide.

Question 14

You are working with an older adult after an acute hospitalization. Your goal is to help this person be more in touch with time, place, and person. What might you try?

1. Reminiscence
2. Validation therapy
3. Reality orientation
4. Body image interventions

Answer 14

Answer: 3.
Reality orientation is a communication technique that can help restore a sense of reality, improve level of awareness, promote socialization, elevate independent functioning, and minimize confusion.

Question 15

A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable around 130/70. The patient does not exercise regularly and complains of weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.)

1. Presence of a chronic disease
2. Impaired vision
3. Residence design
4. Blood pressure
5. Leg weakness
6. Exercise history

Answer 15

Answer: 2, 5, 6.
Risk factors for falling include sensory changes such as visual loss, musculoskeletal conditions affecting mobility (in this case weakness), and deconditioning (from lack of exercise). The mere presence of a chronic disease is not a risk factor unless it is a condition such as a neurological disorder that alters mobility or cognitive function. The patient’s blood pressure is stable, and there is no report of orthostatic hypotension. A one-floor residence should not pose risks.