Question 1

When assessing an older adult client,the nurse notes that the client demonstrates an inability to take purposeful action even when the muscles,senses,and vocabulary appear to be intact.The client appears to register on a command but acts in a way that suggests little understanding of what transpired verbally.The nurse recognizes these assessment findings as consistent with which of the following conditions?

Accepted Answer

Apraxia,defined as the loss of the ability to take purposeful action even when the muscles,senses,and vocabulary seem intact,is a common feature of dementia.The person appears to register on a command but acts in ways that suggest he or she has little understanding of what transpired verbally.Hearing loss associated with normal aging begins after age 50 years and is due to loss of hair cells (which are not replaced)in the organ of Corti in the inner ear.This change leads initially to a loss in the ability to hear high-frequency sounds (e.g.,f,s,th,sh,ch)and is called presbycusis.Although most people weather the necessary losses of life,late life depression is an often untreated problem in older adults.Unlike symptoms of depression in younger people,somatization with vague physical complaints may be its first presenting sign.Polypharmacy is a fact of life for older adults.As people age,many need multiple medications to maintain a healthy lifestyle.Polypharmacy places older adults at risk for side effects and drug interactions because of age-related changes in metabolism.Medications in general have a stronger effect on the older population and take longer to be eliminated from the body.

Question 2

A client diagnosed with dementia is becoming increasingly unable to express complete thoughts and is having difficulty engaging in simple conversations.When communicating with this client,the nurse should

Accepted Answer

Instead of using abstract prompts (like a specific time),the nurse should use words directly applicable to the client's daily routine,like "before lunch," to anchor the client's recognition of time frames.The nurse should restate ideas using the same words and sequence and validate the meaning of a client's response.As dementia progresses,clients become increasingly unable to express complete thoughts and eventually cannot carry on even simple conversations.The nurse should use questions that can be answered with a yes or no for clients with less verbal skill.The nurse should note whether the client's behavior is consistent with the yes or no answer and follow up if the behavior is incongruent with the words.

Question 3

When caring for an older adult client who is experiencing memory loss,the nurse notes that the client emotionally overreacts to situations,appearing as if having temper tantrums when responding to real or perceived frustration.The nurse recognizes the client is experiencing a catastrophic reaction.When caring for this client,the nurse should

Accepted Answer

Instead of focusing on the behavior,the nurse should try to identify and eliminate the cause(s).The nurse should use distraction to move older adults away from the offending stimuli in the environment or use postponement.Older adults with memory loss lack the cognitive ability to develop alternatives.They emotionally overreact to situations and can have what look like temper tantrums in response to real or perceived frustration.Older adult tantrums are called catastrophic reactions and represent a completely disorganized set of responses.Usually there is something in the immediate environment that precipitates the reaction.Fatigue,multiple demands,overstimulation,misinterpretations,or an inability to meet expectations are contributing factors.

Question 4

The nurse has just completed a care plan on a visually impaired client.Which of the following interventions is most appropriate for this client?

Accepted Answer

Adaptive strategies for vision loss include providing bright lighting with no glare,having the nurse stand in front of the client,and considering the font and letter size for readability when using written materials.Upper and lower case letters rather than all capitals should be used.Solid paper with sharp,contrasting writing and a lot of white space should also be used.Adaptive strategies for vision loss also include verbally explaining all written information while allowing time for the client to ask questions.

Question 5

The nurse is caring for an older adult client who has recently experienced losses associated with deaths of important people in her life.The nurse recognizes that this type of problem challenges which of Maslow's hierarchy of needs?

Accepted Answer

Maslow's hierarchy of needs helps nurses prioritize nursing actions,beginning with basic survival needs.Physiological integrity,followed by safety and security,emerge as the most basic critical issues for aging adults,and need to be addressed first.Love and belonging needs are challenged by increased losses associated with death of important people.Esteem needs,especially those associated with meaningful purpose,and independence remain important issues in later life.Abraham Maslow believed that self-actualization occurs more often in middle aged and older adults.Love and belonging needs are challenged by increased losses associated with death of important people.Esteem needs,especially those associated with meaningful purpose,and independence remain important issues in later life.Abraham Maslow believed that self-actualization occurs more often in middle-aged and older adults.

Question 6

The nurse is caring for an older adult client who has been diagnosed with dementia.The nurse recognizes which of the following as true in relation to the use of touch with this client?

Accepted Answer

Touch is something clients with dementia can no longer ask for,create for themselves,or tell another of its meaning.Touch is a form of communication,used to reinforce simple verbal instructions with cognitively impaired adults and as a primary form of communication.It is experienced "not only physically as sensation,but also affectively as emotion and behavior." As dementia progresses,gentle touch can anchor an anxious or disoriented person in present time,space,and humanity.When used to gain a client's attention or to guide a person toward an activity,touch can acknowledge a client's stress,calm an agitated client,or provide a sense of security.In general,clients with dementia appreciate the use of touch.

Question 7

When visiting a client in his or her home,the home health nurse notes that the client frequently shifts the conversation to reminisce.Which of the following communication techniques would be most effective for the nurse to use with this client?

Accepted Answer

Older adults appreciate having the nurse provide structure to the history-taking interview by explaining the reasons for it and what it will involve.Asking clients to share something about themselves and their life history,apart from the reasons for the health visit or admission,helps to establish rapport and increases the client's comfort level.By relating their life stories and exploring options relevant to their current health situation,older adults are able to step back and look at their situation in the present from a broader perspective.Nurses get to know the client as a person rather than categorically as an "older adult." Ego integrity relates to the capacity of older adults to look back on their lives with satisfaction and few regrets,coupled with a willingness to let the next generation carry on their legacy.Integrity involves acceptance of "one's one and only life cycle" as something that had to be and that by necessity permitted of no substitution.Acceptance develops through self-reflection and dialogue with others about the meaning of one's life.Nursing strategies encouraging life review and reminiscence groups facilitate the process.Old age "is shaped by a lifetime of experience." Assessment of older adult clients begins with their story.As they relate their story,the nurse should look for value-laden psychosocial issues (e.g.,independence,fears about being a burden,role changes,and vulnerability)and client preferences.These are significant issues for older adult clients that may not be directly expressed.

Question 8

When assessing an older adult client,the nurse recognizes the client has a significant hearing loss.The most appropriate intervention by the nurse is to

Accepted Answer

Adaptive strategies for hearing loss include helping older adults adjust hearing aids.Older adults lack fine-motor dexterity and may not be able to insert aids correctly to amplify hearing.The nurse should make sure hearing aids are turned on.If difficulties persist,the nurse should check the batteries.Adaptive strategies for hearing loss also include addressing the person by name before beginning to speak (it focuses attention)and speaking slowly and distinctly.If the nurse's voice is high pitched,the nurse should lower it and rephrase rather than repeat words if the older adult doesn't understand certain words.

Question 9

When performing a mental status examination on an older adult client,the nurse discovers that the client is illiterate and only has a third-grade education.How should the nurse assess the client's cognition?

Accepted Answer

The nurse should determine the client's level of formal education.If the client never learned to spell,it will be impossible to spell "world" backwards.Saying the days of the week backwards is a good alternative.Spelling and use of serial 7s would not be an appropriate alternative with this client's level of formal education.

Question 10

When communicating with older adult clients,the nurse recognizes that

Accepted Answer

Hearing problems can diminish an older person's ability to interact with others,attend concerts and other social functions,and understand medical directions.Hearing loss associated with normal aging begins after age 50 due to loss of hair cells (which are not replaced)in the organ of Corti in the inner ear.This change leads initially to a loss in the ability to hear high-frequency sounds (e.g.,f,s,th,sh,ch)and is called presbycusis.Lower-frequency sounds of vowels are preserved longer.Older adults have special difficulty in distinguishing sounds against background noises and in understanding fast-paced speech.

Question 11

The nurse is caring for an older adult client who has early moderate cognitive impairment and has been diagnosed with dementia.When interacting with the client's family,the nurse should teach family members that

Accepted Answer

Remote memory (recall of past events)is retained longer than memory for recent events.Family members can be encouraged to reminisce with dementia clients.This can be a meaningful experience for the family member,even when the client cannot actively engage in the discussion,because it is a means of connecting.It is not uncommon for a dementia client to show through facial expression or garbled words that he/she too experiences the connection,even if only for a fleeting moment.Or it may come later.Asking mild to early moderate cognitively impaired older adults about their past life experiences serves as a way to connect verbally with those who might have difficulty telling you what they had for breakfast 2 hours ago.

Question 12

The nurse is caring for an older adult client.The nurse recognizes that the factor most closely associated with the older adult's inability to live independently is

Accepted Answer

More than any other factor,impaired functional status is a determinant of an older adult's inability to live independently.Stress,acute and chronic illness,and age-related physiologic changes will influence a person's functional status.Functional status,rather than chronologic age,should be the stronger indicator of disability-related needs in older adults because functional impairment is not associated solely with age.

Question 13

The nurse is caring for a frail older adult client who is admitted to the hospital after falling.The client has been living alone independently and appears reluctant to accept assistance.The nurse recognizes that the client's reluctance to accept assistance is most likely caused by fear of

Accepted Answer

The nurse may need to directly observe environmental supports,bearing in mind that a potential association exists in the older adult's mind between accepting help and relinquishing independent living.

Question 14

A client has an order for a new medication.When preparing to administer the medication to the client for the first time,the nurse gets ready to educate the client and the client's daughter about the medication.When educating the client and the daughter,the nurse should do all of the following except

Accepted Answer

Assuming that cognitive intact older adults lack the capacity to understand instructions is a common error.Health care providers often direct instruction to the older adult client's younger companion,even when the client has no cognitive impairment.This action invalidates the client and diminishes self-worth.Simple modifications to reduce age-related barriers to learning when teaching older adults include:
.Explain why the information is important to the client.
.Use familiar words and examples in providing information.
.Draw on the client's experiences and interests in planning teaching.
.Make teaching sessions short enough to avoid tiring the client,and frequent enough for continuous learning support.
.Speak slowly,naturally,and clearly.
Health teaching for the elderly is critical if they are to master the tasks of old age and maintain their health.Healthy older adult learning capabilities remain intact,although older adults may need more time to think about how they want to handle a situation.The sensitive nurse observes the client before implementing teaching and gears teaching strategies to meet the individual learning needs of each client.Four aspects of successful aging-fall prevention,adequate nutrition,socialization,and medication management-lend themselves to health teaching formats.

Question 15

The nurse is performing an admission assessment on a client with cognitive impairment.When developing a plan of care for this client,the nurse should plan to

Accepted Answer

Cognitively impaired clients have trouble following instructions consisting of multiple steps.Breaking instructions into single steps helps these clients master tasks that otherwise are beyond their comprehension.Keep the conversation simple and focused on one step at a time.Asking mild to early moderate cognitively impaired older adults about their past life experiences is a way to connect verbally with those who might have difficulty telling you what they had for breakfast 2 hours ago.Remote memory (recall of past events)is retained longer than memory for recent events.When cognitively impaired adults share memories,they are giving a gift to the nurse by sharing part of themselves when they may have very little else to give.

Question 16

An older adult client tells the nurse,"My life has been a waste." The nurse recognizes this statement as demonstrating which aspect of psychosocial development?

Accepted Answer

Erikson's (1982)model of psychosocial development is used to describe older adult psychosocial development.His is one of the only developmental models that specifically addresses later adulthood (> 60 years)as a stage of ego development.Erikson portrays the maturational crisis of old age as that of ego integrity versus ego despair.Awareness of one's personal mortality leads to the psychosocial crisis identified with this last stage of ego development.Ego despair describes the failure of a person to accept one's life as appropriate and meaningful.Left unresolved,despair leads to feelings of emotional desolation and bitterness.Ego integrity relates to the capacity of older adults to look back on their lives with satisfaction and few regrets,coupled with a willingness to let the next generation carry on their legacy.Lack of generativity and isolation are not stages found in the older adult client.

Quiz 19: Communicating With Older Adults