Promoting Health in Older Adults (23) Flashcards
The nurse provides care for an older adult whose husband died 8 months ago. Which of the following behaviors indicates that the client is experiencing effective coping? Select all that apply.
- ) Shows the nurse photographs of her family.
- ) Refuses to keep her beauty appointments.
- ) Visits her husband’s grave every 2 weeks.
- ) Attends church on a regular basis.
- ) Increases her consumption of alcohol.
1.) Shows the nurse photographs of her family.
3.) Visits her husband’s grave every 2 weeks.
4.) Attends church on a regular basis.
Grieving is a normal behavior after the death of a loved one, and the behaviors listed in options 1, 3, and 4 indicate signs of normal grieving. When grieving becomes extreme, and signs of self-neglect or alcohol or substance abuse are obvious, ineffective coping may be a problem. The nurse needs to be attentive to the problem and be prepared to call on appropriate resources, if needed.
A nurse in a long-term care facility is caring for several older adults with noticeable hearing losses. Which is the best way for the nurse to communicate with these clients?
- ) Speak slowly using the proper volume and as few words as possible.
- ) Write the information using large lettering.
- ) Speak in a low and distinct voice tone.
- ) Have the client increase the volume in the hearing aid.
3.) Speak in a low and distinct voice tone.
Because the hearing loss occurs in the ability to distinguish high-pitched tones, speaking in a low and distinctive voice tone is the most appropriate method of communicating with the clients. Hearing loss in the older adult includes a loss of the ability to discern higher frequencies, and speaking slowly at a particular volume is not the best way to communicate with the clients (option 1). The stem indicates the clients have noticeable hearing loss, but does not indicate the clients are deaf; large lettering is appropriate if the client has a visual problem (option 2); hearing aids are not usually effective when the problem is related to neural damage (option 4).
The nurse observes that an 85-year-old man at an adult day care center fondly shares stories about traveling on the “orphan trains” and his subsequent adoption. Following a behavioral assessment, the nurse should perform which interventions?
- ) Refer him for a geriatric psychiatric evaluation.
- ) Listen and ask him questions about his life.
- ) Distract him and change the conversation.
- ) Involve him in more social activities.
2.) Listen and ask him questions about his life.
Reminiscence about past life events, doing a “life review” of past experiences, especially if they were positive, is considered to be a normal psychosocial activity of older adults. It helps them focus on past accomplishments and contributions to society, thus increasing their self-concept. If behavioral or significant memory problems had been noted, then a geriatric psychiatric consult would be appropriate, but not in this situation (option 1). Other social activities and conversations should certainly be encouraged, but not to the point of demeaning the importance of his life stories (options 3 and 4).
The home health nurse evaluates an older adult for depression. The client’s daughter is present and comments, “I don’t see the need for this evaluation. Aren’t all older people depressed?” Which is the nurse’s best initial response?
- ) “How many losses has your mother had?”
- ) “Your mother looks so depressed.”
- ) “How long has she been depressed?”
- ) “Depression is not a normal part of aging.”
4.) “Depression is not a normal part of aging.”
It is a myth regarding the aging process that most old people are depressed. By relating that depression is not a normal part of aging, the nurse can further dialogue with the daughter. The older client’s number of losses is less important than how she copes (option 1). A depressed affect may be the older adult’s usual look (option 2). It is yet to be determined if in fact she is depressed (option 3).
While being admitted to a rehabilitation unit, an 82-year-old woman mentions to the nurse that she “has trouble holding her water,” adding “if I could have that tube back in me like I had in the hospital, I wouldn’t have so many accidents.” What is the nurse’s best response?
- ) “Don’t worry, the staff will bring plenty of pads to keep you dry.”
- ) “I’ll put the tube back in you so you will stay dry.”
- ) “Tell me more about your problem.”
- ) “Just call the staff and we’ll help you to the bathroom in time.”
3.) “Tell me more about your problem.”
This option will provide the nurse with the most information for potential intervention. Options 1, 2, and 4 are incorrect because urinary incontinence is not normal and it is something the nurse should investigate.
The nurse notices that when an 80-year-old man rises from a seated position, the client uses both arms to push himself up, and also “rocks” back and forth before finally standing. What is the most appropriate nursing intervention for this client?
- ) Suggest a referral to physical therapy for strengthening ex)ercises.
- ) Request a waist restraint to remind the client not to stand by himself.
- ) Praise the client for his attempts to remain independent.
- ) Assist the client to rise by grasping both his shoulders and pulling forward.
1.) Suggest a referral to physical therapy for strengthening ex)ercises.
The client has lost muscle strength. Strengthening exercises will improve his mobility and lessen the possibility of a fall. Option 2: Information indicates the client has difficulty rising from a seating position, not standing after he reaches the position; further assessment is needed before implementing this intervention. Option 3: Praise should come after the proper intervention is implemented and a plan is in place so that the praise is focused toward a goal to resolve the problem. Option 4 resolves the problem immediately but does nothing to resolve the underlying problem.
A healthy 78-year-old woman who is considering marriage to a healthy 79-year-old neighbor tells the nurse that she wonders if they will be able to have sexual intercourse. Which is the nurse’s most appropriate response?
- ) “Sexual activity may be too demanding for your heart.”
- ) “Older women maintain sexual function, but most older men are impotent.”
- ) “Most older people are not interested in sexual activity.”
- ) “Both of you may have slower responses to sexual stimulation.”
4.) “Both of you may have slower responses to sexual stimulation.”
Sexual activity is possible for older adults although the responses are slower. The clients would need a health history and physical assessment of the cardiovascular system before drawing this conclusion (option 1). With the introduction of Viagra, older men are more able to perform than in the past (option 2). Older men’s interest tends to decline, but it is not known whether it is related to impotence; apparently this older client is interested in sexual activity (option 3).
The client complains of having difficulty clearly seeing the words in the newspaper unless he holds the newspaper an arm’s length away. The nurse uses which terminology to document this assessment?
- ) Presbycusis
- ) Xerostomia
- ) Presbyopia
- ) Presbyesophagus
3.) Presbyopia
Presbyopia is loss of near vision related to aging. Option 1 is loss of hearing ability related to aging. Option 2 is dry mouth related to a decrease in saliva, and option 4 is a decrease in the motility of the esophagus related to aging.
The nursing student is planning care for an older adult who had a total knee replacement yesterday evening. Which nursing intervention would be most appropriate?
- ) Ask the client how much of his bath he can independently perform.
- ) Ask the client if he has any questions regarding discharge from the hospital.
- ) Tell the client that he needs to decide when he wants his medications.
- ) Tell the client that he needs to rest and will be given a complete bed bath.
4.) Tell the client that he needs to rest and will be given a complete bed bath.
This response reflects an understanding of the different stages of independence and control an older adult experiences when admitted to the hospital and the need for the nurse to assess the client’s need for control and autonomy. After admission, the client willingly gives up autonomy to the hospital routine because the client wants to get better (option 4). As the client’s health improves and progresses, he or she wants to increase autonomy (option 1). Before discharge the client is thinking about if he or she can go home (option 2). Option 3 is not realistic given the usual hospital routine.
A 76-year-old woman with dementia lives in an assisted living facility and often asks, “When will my sister come to visit me this afternoon?” The sister passed away last year. Which is the best response from the nurse?
- ) “This is so sad. I’m sorry to tell you but your sister died last year.”
- ) “She won’t be coming to visit today.”
- ) “I understand you want her to visit you. Where did you and your sister grow up?”
- ) “Wait and see if she comes to visit today.”
3.) “I understand you want her to visit you. Where did you and your sister grow up?”
The nurse treats the older woman with empathy. Saying the sister is dead may trigger agitation or an argument. It may start the grieving process all over again and be distressing for the woman (option 1). These responses should be avoided. It is more compassionate to focus on the woman’s feelings, and encourage her to talk about her sister and remembered events. Long-term memory remains functional in many clients with dementia compared to short-term memory. By having her reminisce, the nurse can stimulate the woman’s recall of events from a long time ago (option 3). It is deceptive to say the sister won’t visit today or that the woman should wait to see if she does visit today (option 4).
