Exam 1 - Chapter 3

Question 1

The nurse is aware the theory of aging most likely to explain why the older population is at
risk for autoimmune disorder is known as:
a. cross-link theory.
b. free radical theory.
c. error theory.
d. autoimmune theory.

Answer 1

D - The immunity theory proposes that cellular errors in the immune system have been found to
lead to an auto-aggressive phenomenon in which normal cells are misidentified as alien and
are destroyed by the body’s own immune system. This phenomenon is used to explain the
increase of autoimmune disorders as we age. The cross-link theory describes aging in terms of
the accumulation of errors of cross-linking or stiffening of proteins in the body. The free
radical theory describes free radical errors as the result of random damage from free radicals.
The error theory is a group of theories that propose that aging is an accumulation of errors in
the synthesis of cellular DNA and RNA, which are the building blocks of the cell.

Question 2

The family member of a patient if vitamin C will prevent aging. In formulating an
appropriate response, the nurse considers the:
a. free radical theory.
b. autoimmune theory.
c. wear-and-tear theory.
d. continuity theory.

Answer 2

A - The free radical theory posits that aging is a result of random damage from free radicals.
Research is ongoing on the ability of substances with antioxidant effects to counter the actions
of free radicals. For many years it was thought that consumption of supplemental antioxidants,
such as vitamin C, could delay or minimize the effects of aging. However, it is now known
that the intake of supplemental antioxidants can be deleterious to one’s health. The
autoimmune theory posits that the cells of the immune system become progressively more
diversified with age and lose self-regulatory ability. The use of vitamin C is not associated
with this theory. The wear-and-tear theory posits that cellular errors are the result of wearing
out over time due to constant use. The continuity theory is a sociological theory that deals
with the tendency of individuals to develop and maintain consistent patterns of behavior
throughout their lives.

Question 3

The nurse implements the concepts of the activity theory of aging when instructing the older
client with osteoarthritis to:
a. continue her daily walking routine.
b. curtail further increases in physical activity.
c. document preferred end-of-life interventions.
d. avoid exposing herself to crowds.

Answer 3

A - The activity theory states that successful aging equals active aging, which is related to the
person’s need to maintain a productive life for it to be a happy life. Curtailing increases in
physical activity is diametrically opposite to continuing a daily walking routine and contrary
to the tenets of the activity theory. End-of-life decisions and avoiding exposure to crowds are
not related to the activity theory since they do not directly affect the productiveness of a
client’s life.

Question 4

A community health nurse provides an annual flu prevention workshop at a local senior
center. The activities include a lecture on preventing infections, which includes hand washing
and limiting exposure to individuals who are ill, as well as an influenza immunization clinic.
The nurse is basing her activities on what theory of aging?
a. Wear and tear
b. Oxidative stress
c. Autoimmune
d. Free radical

Answer 4

C - The autoimmune theory of aging describes changes in cells of the immune system, which
make an older person more susceptible to infection. Prevention of infection is very important
in older adults and can be accomplished by education and immunization. Wear and tear,
oxidative stress, and free radical are incorrect because none of these theories of aging deal
with prevention of infection.

Question 5

A 66-year-old retired professional basketball player is admitted to the hospital for a total knee
replacement due to osteoarthritis. In preparing preoperative teaching for this patient, the nurse
includes which theory of aging to help him understand how the disease has progressed?
a. Free radical theory
b. Wear-and-tear theory
c. Gene theory
d. Cross-link theory

Answer 5

B - Osteoarthritis is characteristic of degeneration that results from joint usage. This disease is a
good example of the wear-and-tear theory; repeatedly injuring one organ or body system, such
as occurs during playing sports, may result in premature aging and diseases such as
osteoarthritis. The free radical theory states that cell damage is a result of the accumulation of
oxygen radicals. The gene theory states that genes govern cellular mortality. The cross-link
theory is related to the accumulation of cross-linked proteins, which may cause disease

Question 6

A married couple retired to a life care community after the husband had heart surgery. The
wife has always been physically and socially active and joined an aerobic class, knitting
groups, and a book club shortly after moving to the community. She walks on a daily basis
and swims twice a week. Her husband spends his days reading and watching television. He
was never a social person and enjoys being by himself. Which of the sociological theories of
aging best describes the couple?
a. Role theory
b. Disengagement theory
c. Continuity theory
d. Personality theory

Answer 6

C - The continuity theory asserts that individuals tend to develop and maintain a consistent pattern
of behavior as they age. The wife was active and social and continues to be so. Her husband
was not very social and preferred less active activities and continues to do so. The role theory
describes that people engage in roles consistent with their chronological age. The scenario
above describes activity levels, not roles. The disengagement theory describes withdrawal of
older adults from roles and activities of earlier life. Personality theories are distinct and
different from sociological theories of aging.

Question 7

A nurse plans programs for older adults in a senior center. She organizes a series of exercise
programs. She sets one up for clients ages 65-74, one for clients 74-85, and one for clients
over age 85. The nurse is utilizing which theory of aging?
a. Gerotranscendence
b. Activity theory
c. Age-stratification theory
d. Continuity theory

Answer 7

C- Age-stratification theory considers individuals as members of cohorts with similarities to
others in the same group. The importance of the similarities exceeds that of the differences.
Gerotranscendence theory posits that older adults withdraw from society, in order to give the
individual the opportunity for self-reflection and exploration. Time, material possessions, and
superficial relationships have less meaning. Activity theory proposes that continued activity
contributes to successful aging. Continuity theory posits that individuals develop and maintain
a consistent pattern of behavior over a lifetime.

Question 8

The nurse shows an understanding of the error group of aging theories when stating: (Select
all that apply.)
a. “Aging occurs differently for the various ethnic groups.”
b. “Our genetic makeup is responsible for how we are affected by age.”
c. “Aging is a result of mistakes in our RNA and DNA metabolism.”
d. “The free radical theory is an example of an error theory.”
e. “Aging effects are really random and unpredictable.”

Answer 8

C,D,E - Answers A and B are congruent with programmed (nonerror) theories. The programmed
theories are those in which the changes of aging are attributed to a process that is programmed
and thought to be predetermined such as in the various ethnic groups. Research is currently
looking at genes being responsible for aging. The programmed theories view aging as
predetermined and not random. The error theories propose that aging is the result of an
accumulation of errors in the synthesis of cellular DNA and RNA synthesis, and that changes
related to aging are random and unpredictable. The free radical theory is an error theory.

Question 9

The nurse preparing wellness information for older adult clients is promoting interventions
consistent with the concepts of the biological theories of aging when suggesting that they:
(Select all that apply.)
a. use moisturizers daily to minimize dry skin.
b. discuss the use of antacids to control heartburn with their health care provider.
c. stay active by interacting with family and friends regularly.
d. practice stress reduction techniques on a regular basis.
e. consider getting a yearly influenza vaccination.

Answer 9

A,B,D,E - Interventions that promote biological theories of aging include those that help avoid skin
dryness and the overuse of antacids (cross-link) as well as the minimization of stress and risk
for viral infections (oxidative stress, immunity). Remaining physically active and emotionally
connected is consistent with the psychosocial theories of aging.

Question 10

A nurse demonstrates understanding of the continuity theory when the nurse provides which
of the following advice to an older client? (Select all that apply.)
a. “It is important to think about the activities that have been most satisfying for you
throughout your adult life and make a plan to continue them”
b. “Since you enjoyed teaching young children so much, perhaps you would enjoy
volunteering in the day care center”
c. “It is important to save enough money so that you will have an adequate income
during retirement”
d. “It is important to maintain an active lifestyle as you age”
e. “As you get older it is natural to slowly disengage oneself from many activities”

Answer 10

A,B - Continuity theory posits that individuals develop and maintain a consistent pattern of behavior
over a lifetime. Successful aging is associated with one’s ability to maintain and continue
previous behaviors and roles or find suitable replacements. Options A and B demonstrate this
theory. Option C demonstrates the social exchange theory, which is conceptualized from an
economic perspective. Option D demonstrates the activity theory, and Option E demonstrates
the disengagement theory.

Question 11

Gerotranscendence theory posits that: (Select all that apply.)
a. older adults withdraw from society in order to allow the transfer of power to
younger individuals.
b. older adults withdraw from society in order to give the individual an opportunity
for self-reflection and self-exploration.
c. time and superficial relationships become less important.
d. material possessions have less meaning.
e. status and value of elders is lost because of their contritributions are no longer valued

Answer 11

B,C,D - Disengagement theory posits that older adults withdraw from society in order to allow the
transfer of power to younger adults. Gerotranscendence theory posits similarly that older
adults withdraw from society, but for different reasons. These reasons include giving the
individual the opportunity for self-reflection and exploration. Time, material possessions, and
superficial relationships have less meaning. The modernization theory posits that the status
and value of elders is lost because their contributions are no longer valued.

Question 12

Name the theory of aging that suggests that the adverse physical effects of aging are the result of a gradual loss of control mechanisms in the pituitary and hypothalamus.

a. Free-radical theory
b. Programmed theoryd
c. Schochtastic theory
d. Neuroendocrine theory

Answer 12

D - The neuroendocrine theory attributes aging to gradual changes in or the loss of the mechanisms that control the organs through chemical signals. The free-radical theory attributes aging to the accumulation of destructive products of metabolic oxidation. The programmed theory attributes aging to cells exhausting a predetermined number of replications. A stochastic theory attributes aging to the accumulation of random damage to DNA and other molecules.

Question 13

Decreased functioning of which physical structure is likely to result in decreased metabolism in older adults?

a. Kidney
b. Thyroid
c. Brain
d. skeleton

Answer 13

B - Secretion of t
hyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis.

Question 14

An older female patient is reading a large-print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement?

a. Put a high-intensity lamp at the head of her bed.
b. Explain to her that the gray-yellow ring around her cornea, arcus senilis, is interfering with visual acuity.
c. Put more powerful tubes in the fluorescent room lights.
d. Examine her retinas for signs of damage.

Answer 14

A - The pupil becomes gradually smaller with age; therefore the eye requires three times as much light. A high-intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment.

Question 15

Aging ordinarily leads to decreases in which of the following?

a. Creatinine clearance and insulin secretion
b. Blood carbon dioxide and saliva production
c. Left ventricle-wall thickness and skin healing time
d. Serum triiodothyronine (T3) and gastric pepsin

Answer 15

D - Serum T3 and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle-wall thickness and skin healing time both increase with aging.

Question 16

Which change in the skin is abnormal in an older person?

a. Thinner and more fragile skin
b. Red, swollen 3-day-old wound
c. greater number of freckles
d. Loss of hair on the extremities

Answer 16

B - Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease.

Question 17

The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program?

a. Room with a beautiful hardwood floor tastefully appointed with throw rugs
b. Spacious room with no windows but with fluorescent lighting and a natural stone floor
c. Room with a hardwood floor and large windows overlooking a garden area
d. End room with a linoleum floor and a fan for ventilation to compensate for the rooms broken air conditioner

Answer 17

C - The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. The fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat.

Question 18

The latest trends in medicine encourage health care providers to prescribe nutrient-dense foods and exercise to prevent or delay the shortening of telomeres. On which biological theory of aging are these practices based?

a. Genetic research
b. caloric restricted
c. packemaker theory
d. cross-link theory

Answer 18

A - Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leading to stiffer joints, rougher skin, and decreased cellular elasticity.

Question 19

During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance?

a. Exercise with light weights.
b. Stand on one foot at a time while supported.
c. Train with the use of sit-ups.
d. Work out in a swimming pool.

Answer 19

B - The loss of balance from a musculoskeletal perspective is usually due to a loss of core muscle strength, thus the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance.

Question 20

The nurse cares for an older adult who has a prealbumin level of 10 mg/dl and an infection in a large wound. Which intervention is the nurses priority?

a. Monitor temperature and leukocytes.
b. Provide assistance with meal planning.
c. Provide high-quality protein in the diet.
d. Maintain oxygen saturation above 95%.

Answer 20

D - The nurses priority is to maintain oxygen saturation above 95% to help provide oxygen that the heart is unable to provide. The heart of this older adult is less able to respond to increased oxygen demands from infection because of age-related changes in the myocardium including ventricular hypertrophy and decreased coronary blood flow and changes in pulmonary function. Further, because this older adult is malnourished and thus likely to have anemia, any capacity to meet increased oxygen demand is stymied. Along with airway, breathing and circulation are two of the three most basic needs. Similarly, the older heart may not be able to respond to other calls for increased cardiac demand such as infection, anemia, pneumonia, cardiac dysrhythmias, surgery, diarrhea, hypoglycemia, malnutrition, and drug-induced and noncardiac illnesses such as renal disease and prostatic obstruction.
Monitoring temperature and leukocytes is important to implement for anyone with an infection, but it is not as important as breathing and circulation. Besides, fever is an unreliable indicator of infection in an older adult. Providing assistance with meal planning is a reasonable nursing intervention, but it is not as important as breathing and circulation. The nurse provides high-quality protein in this individuals diet because of malnutrition, but this teaching is not as important as breathing and circulation.

Question 21

An older man who paints houses for a living has had a myocardial infarction (MI). Which intervention should the nurse implement to prevent adverse health effects from his occupational history?

a. Provide low-cholesterol diet meals.
b. Avoid substances that are hepatotoxic.
c. Promote coughing and deep breathing.
d. Analyze the electrocardiograms rhythm.

Answer 21

C - The nurse implements coughing and deep breathing because of the older mans history of exposure to environmental toxins from the paint vapor. Therefore to promote oxygenation and ventilation and to prevent atelectasis and pneumonia, the nurse instructs him to cough and deep breathe at regular intervals. Hypercholesterolemia is a common co-morbidity with coronary artery disease; if his total cholesterol is greater than 200 mg/dl, then the nurse should provide a low-cholesterol diet. Inhalation of paint vapor over a long period has adverse effects primarily on the lungs. However, some hepatotoxic substances are used in health care, such as immunosuppressants and aminoglycoside antibiotics, and must be given to this individual with caution. Because he had a MI, the nurse closely monitors the hearts rhythm to detect ventricular dysrhythmias, tachycardia, and other potentially harmful rhythms, but such abnormal rhythms are unlikely to be directly related to his occupational history.

Question 22

The nurse administers an antibiotic and naproxen to an older woman. Which laboratory test result should the nurse monitor to gauge the older adul’ts response to the medication?

a. Urine creatinine
b. indirect bilirubind
c. serum creatinine
d. total hemoglobin

Answer 22

A - Antibiotics and nonsteroidal antiinflammatory agents such as naproxen can cause kidney damage from various mechanisms; thus the nurse monitors the urine creatinine because it reflects the systems ability to clear waste products and is especially important for gauging appropriate medication administration. Unconjugated (indirect) bilirubin reflects the livers ability to conjugate serum bilirubin. Serum creatinine, also a reflection of renal function, usually remains stable throughout life. Older adults may have changes in hemoglobin and erythrocyte synthesis caused by changes in iron and vitamin B12 absorption.

Question 23

.An older adult who recently had surgery complains of pain at the level of 3 out of 10 and constipation during the postoperative primary care visit. Which intervention should the nurse implement to first facilitate elimination?

a. encourage the use of a laxative
b. review the medication list
c. promote fiber in the diet
d. suggest adding fluid intake

Answer 23

B - The nurse begins by reviewing the medication list to find substances that are likely to cause constipation such as opioid analgesics and antidepressants, among others. If the patient is taking an opioid analgesic and because the patient rates the pain as 3 out of 10, then a change in pain medication can help relieve constipation. The use of a laxative can be contraindicated and is the therapy of last resort for constipation caused by factors other than opioid analgesics. Promoting fiber in the diet is a reasonable intervention but can be made unnecessary by omitting the opioid analgesic. Increasing fluid intake is a reasonable nursing intervention for older adults with and without constipation, but it can be unnecessary for this older adult.

Question 24

Which age-related change contributes to anorexia and weight loss in the older adult?

a. excessive saliva
b. fewer taste buds
c. wearing dentures
d. softenend email enamel

Answer 24

B - The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel.

Question 25

The nurse assigns the diagnosis of Nutrition Imbalance: less than body requirements for an older adult. Which age-associated intestinal problem does the nurse apply to plan goals and interventions to improve this adults nutritional status?

a. less intrinsic factor secretion
b. short, broad small intestinal villi
c. decreased gastric smooth recipe
d. decreased large intestinal motility

Answer 25

B - Villi of the small intestine shorten and widen with age and, as a result, become less functional, which contributes to malabsorption of nutrients; despite a healthy diet, nutrients are absorbed primarily in the small intestines. The concept of malabsorption is what the nurse uses to plan care; this nursing diagnosis refers to the inability of the body to absorb nutrients as a result of biological factors. Decreased intrinsic factor secretion leads to pernicious anemia as a result of the inability to absorb vitamin B12 in the stomach. Gastric smooth muscle is not present in the intestines. Decreased large intestine motility is an age-associated problem; however, it should have no impact on absorption in the small intestine.

Question 26

Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.)

a. Fewer T-lymphocytes
b. Less lean muscle mass
c. Decreased thyroid function
d. Decreased physical activity
e. Left ventricular hypertrophy
f. Decreased insulin sensitivity

Answer 26

B,C,D,F - Less lean muscle mass means that the body has fewer insulin receptor sites; thus glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, the older adult must increase physical activity and decrease food consumption.
Fewer T-lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes.

Question 27

During a walk, an older man suffers a laceration from a broken tree branch. Rank the nurses interventions in order, beginning with the most important intervention.

a. Flush and cleanse the wound well.
b. Investigate a possible safety hazard.
c. Instruct him to keep the wound covered.
d. Verify a current tetanus immunization.

Answer 27

A,B,C,D - Flushing and cleansing the wound helps prevent the invasion of potential pathogens from the tree into the mans system. This most basic nursing intervention is the nurses first priority because it helps maintain physiological functioning. Without the wound being clean, the remaining nursing interventions cannot be effective. The second most important task for the nurse is to instruct the patient to keep the wound covered; the inflammatory response can take 48 to 72 hours to begin in an older adult. Covering the wound will help keep the wound clean and prevent contamination. Without the action of the bodys defense mechanisms at the wound in an older adult, inflammatory mediators remain inactive, allowing potential pathogens to remain unchecked, increasing the risk for infection. The third most important task is for the nurse to ensure that the older adult has a current tetanus immunization; tetanus is associated with breaks in the skin. The lowest-priority task for the nurse is to ensure the broken tree branch does not present a safety hazard; therefore the nurse questions the older adult for additional information and takes any necessary action to prevent another accident.

Question 28

The Healthy People 2020 document identified which goals for immunizations? (SATA)

a. Increase percentage of persons who receive a seasonal influenza immunization; 65 years of age or over and living in the community
b. Increase percentage of persons who are vaccinated against herpes zoster, 60 years of age or over
c. Increase percentage of persons who are vaccinated against pneumococcal disease; 65 years of age or over and living in the community
d. Increase percentage of persons who are vaccinated against human papillomavirus (HPV); 60 years of age or over

Answer 28

A,B,C - According to the Healthy People 2020 document, the goals are to increase the percentage of persons who receive a seasonal influenza immunization; 65 years of age or over and living in the community; to increase the percentage of persons who are vaccinated against herpes zoster, 60 years of age or over; and to increase the percentage of persons who are vaccinated against pneumococcal disease; 65 years of age or over and living in the community. Increasing the percentage of persons vaccinated against HPV, 60 years of age or over, is not a goal. After age 27 years, an immunization for HPV is not
recommended

Question 29

When caring for an older man patient, the nurse is aware that which changes are associated with the male reproductive system and aging? (Select all that apply.)

a. testes soften
b. seminiferous tubules thickened
c. sperm count decreases
d. ejaculation is slower

Answer 29

A,B,D - Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beginning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sperm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer.