Chapter 8 - Care of Older Adult Flashcards
The nurse is providing care for an 82-year-old client whose signs and symptoms of Parkinson disease have worsened over the past several months. The client reports no longer being able to do as many things as in the past. Based on this statement, what issue is of most concern to the client?
A. Neurologic deficits
B. Loss of independence
C. Age-related changes
D. Tremors and decreased mobility
B. Loss of independence
Rationale: This client’s statement places a priority on a loss of independence, not specific symptoms. This is undoubtedly a result of the neurologic changes associated with the disease, but this is not the focus of the statement. This is a disease process, not an age-related physiologic change.
Which age-related physiologic change contributes to heart disease being the leading cause of death in older adults?
A. Heart muscle and arteries lose their elasticity.
B. Systolic blood pressure decreases.
C. Resting heart rate decreases with age.
D. Atrial-septal defects develop with age.
A. Heart muscle and arteries lose their elasticity
Rationale: The leading cause of death for clients over the age of 65 years is cardiovascular disease. With age, heart muscle and arteries lose their elasticity, resulting in a reduced stroke volume. As a person ages, systolic blood pressure does not decrease, resting heart rate does not decrease, and atrial-septal defects are not more likely to develop with age
An occupational health nurse overhears an employee talking to a manager about a 65-year-old coworker. Which phenomenon should the nurse identify when hearing the employee state to the coworker, “You should just retire and make way for some new blood”?
A. Intolerance
B. Ageism
C. Dependence
D. Nonspecific prejudice
B. Ageism
Rationale: Ageism refers to prejudice against the aged. Intolerance is implied by the employee’s statement, but the intolerance is aimed at the coworker’s age. The employee’s statement does not raise concern about dependence. The prejudice exhibited in the statement is very specific.
An 80-year-old client is being admitted for dehydration and syncope. The client is found to be hypotensive, and intravenous fluids are ordered. What are some teaching strategies that the nurse should review with this client?
A. Before ambulation the client should rise slowly and take mini breaks between lying, sitting, and standing.
B. Increase consumption of meals to three times a day, with the largest meal being at breakfast.
C. The client must use a rolling walker and call for assistance with any change in position.
D. The temperature in the room should stay very hot, and bathing in hot water is appropriate.
A. Before ambulation the client should rise slowly and take mini breaks between lying, sitting, and standing
Rationale: A client experiencing hypotension should rise slowly. The client should consider having five or six small meals a day to minimize hypotension that can occur after a large meal. Extremes in temperature, especially hot showers, should be avoided. Hot temperatures can cause an increase in blood flow and cause dizziness. Every client does not need a rolling walker. Changes in position, especially in bed, should be done independently and often to prevent pressure ulcers.
A 76-year-old client is in the emergency department with reports of nausea, dyspnea, and shoulder pain. The spouse stated the client woke up confused, slightly unsteady, and pale. Which problem or condition is most likely occurring?
A. Myocardial ischemia
B. Urinary tract infection (UTI)
C. Lung cancer
D. Chronic obstructive pulmonary disease (COPD)
A. Myocardial ischemia
Rationale: Older adults may have atypical pain or burning that may be in the upper body rather than substernal. Clients may report vague symptoms such as nausea, vomiting, syncope, mental status changes, and dyspnea. A UTI may present with mental status changes, but additional signs and symptoms include frequent, urgent, and/or painful urination. Lung cancer and COPD both usually present with more specific respiratory changes, such as wheezing and persistent coughing.
A 65-year-old client has come to the clinic for a yearly physical. The client reports enjoying good health, but also reports having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest?
A. Reduce the amount of stress the client currently experiences.
B. Increase carbohydrate intake and reduce protein intake.
C. Take herbal laxatives, such as senna, each night at bedtime.
D. Increase daily intake of water.
D. Increase daily intake of water.
Rationale: Constipation is a common problem in older adults, and increasing fluid intake is an appropriate early intervention. This should likely be attempted prior to recommending senna or other laxatives. Stress reduction is unlikely to wholly resolve the problem, and there is no need to increase carbohydrate intake and reduce protein intake.
An 80-year-old client has been admitted to the hospital for hypertension and now requires oxygen. The client asks the nurse why oxygen is needed because they have never smoked and feel fine. The client requires oxygen in the hospital because of which respiratory changes or requirements?
A. As a therapeutic measure to encourage coughing and deep breathing
B. Diminished respiratory efficiency and declining aerobic capacity
C. To increase inspiratory and expiratory force of lungs
D. Lung mass increases and residual volume decreases
B. Diminished respiratory efficiency and declining aerobic capacity
Rationale: Diminished respiratory efficiency and declining aerobic capacity are related to age. Older, healthy adults are usually able to compensate for these changes, but stress from illness may increase the demand for oxygen. Oxygen is a drug and not used to encourage cough and deep breathing. Reduced maximal inspiratory and expiratory force may occur in the lungs due to calcification and weakening of the muscles of the chest wall. Lung mass decreases and residual volume increases as the client ages
The nurse is providing education to a client with early-stage Alzheimer disease (AD) and the family members. The client has been prescribed donepezil hydrochloride. What should the nurse explain to the client and family about this drug?
A. It slows the progression of AD.
B. It cures AD in a small minority of clients.
C. It removes the client’s insight that they have AD.
D. It eliminates the physical effects of AD and other dementias.
A. It slows the progression of AD
Rationale: There is no cure for AD, but several medications have been introduced to slow the progression of the disease, including donepezil and hydrochloride These medications do not eliminate the client’s AD but can alleviate some of the symptoms.
A nurse is caring for an 81-year-old client who has become increasingly frail and unsteady when standing. During the assessment, the client reports having fallen three times in the month, though the client did not suffer any injury. The nurse should take action in the knowledge that this client is at a high risk for which type of injury?
A. A hip fracture
B. A femoral fracture
C. Pelvic dysplasia
D. Tearing of a meniscus or bursa
A. A hip fracture
Rationale: The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture
The case manager is working with an 84-year-old client newly admitted to a rehabilitation facility. When developing a care plan for this client, which factors should the nurse identify as positive attributes that enhance coping in this age group? Select all that apply.
A. Decreased risk taking
B. Effective adaptation skills
C. Avoiding participation in untested roles
D. Increased life experience
E. Resilience during change
B. Effective adaptation skills
D. Increased life experience
E. Resilience during change
Rationale: Because changes in life patterns are inevitable over a lifetime, older clients need resilience and coping skills when confronting stresses and change. It is beneficial for older clients to continue to participate in risk taking and new, untested roles, not to avoid them, to help build confidence and develop new skills
A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Which age-related change should the nurse be aware of when planning the appropriate administration of this drug? An older adult client has:
A. less subcutaneous tissue and less muscle mass than a younger client.
B. more subcutaneous tissue and less durable skin than a younger client.
C. more superficial and tortuous nerve distribution than a younger client.
D. a higher risk of bleeding after an IM injection than a younger client.
A. less subcutaneous tissue and less muscle mass than a younger client.
Rationale: When administering IM injections, the nurse should remember that in an older client, subcutaneous fat diminishes, particularly in the extremities. Muscle mass also decreases. There are no significant differences in nerve distribution or bleeding risk
The admissions department at a local hospital is registering a 78-year-old client for an outpatient diagnostic test. The admissions nurse asks if the client has an advance directive. The client reports not wanting to complete an advance directive because they do not want anyone controlling their finances. What would be appropriate information for the nurse to share with this client?
A. “Advance directives are not legal documents, so you have nothing to worry about.”
B. “Advance directives are limited only to health care instructions and directives.”
C. “Your finances cannot be managed without an advance directive.”
D. “Advance directives are implemented when you become incapacitated, when you will use a living will to allow the state to manage your money.”
B. “Advance directives are limited only to health care instructions and directives.”
Rationale: An advance directive is a formal, legally endorsed document that provides instructions for care (living will) or names a proxy decision maker (durable power of attorney for health care) and covers only issues related specifically to health care. They do not address financial issues. Advance directives are implemented when a client becomes incapacitated, but financial issues are addressed with a durable power of attorney for finances or a living will.
A nurse is planning discharge education for an 81-year-old client with mild short-term memory loss. The discharge education will include how to perform basic wound care for the venous ulcer on the client’s lower leg. When planning the necessary health education for this client, the nurse should take which action?
A. Set long-term goals with the client.
B. Provide a list of useful websites to supplement learning.
C. Keep visual cues to a minimum to enhance the client’s focus.
D. Keep teaching periods short
D. Keep teaching periods short
Rationale: To assist the older adult client with short-term memory loss, the nurse should keep teaching periods short, provide glare-free lighting, link new information with familiar information, use visual and auditory cues, and set short-term goals with the client. The client may or may not be open to the use of online resources.
The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address?
A. A decrease in cognition, judgment, and memory
B. A decrease in muscle mass and bone density
C. The disappearance of sexual desire for both men and women
D. An increase in sebaceous and sweat gland function in both men and women
B. A decrease in muscle mass and bone density
Rationale: Normal signs of aging include a decrease in the sense of smell, a decrease in muscle mass, a decline but not disappearance of sexual desire, and decreased sebaceous and sweat glands for both men and women. Cognitive changes are usually attributable to pathologic processes, not healthy aging
A home health nurse makes a home visit to a 90-year-old client who has cardiovascular disease. During the visit the nurse observes that the client has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do?
A. Increase the frequency of the client’s home care.
B. Have a family member check in on the client in the evening.
C. Arrange for the client to see their primary care provider.
D. Refer the client to an adult day program.
C. Arrange for the client to see their primary care provider
Rationale: In more than half of the cases, sudden confusion and hallucinations are evident in multi-infarct dementia. This condition is also associated with cardiovascular disease. Having the client’s home care increased does not address the problem, neither does having a family member check on the client in the evening. Referring the client to an adult day program may be beneficial to the client, but it does not address the acute problem the client is having. The nurse should arrange for the client to see their primary care provider.
