Question 1

What is a priority nursing intervention to prevent falls for an older adult client with multiple chronic diseases?

Accepted Answer

Advanced age and multiple illnesses,particularly those that result in alterations in sensation,such as diabetes,predispose this client to falls.The nurse should provide assistance to the client with transfer and ambulation to prevent falls.The client should not be restrained or maintained on bedrest without adequate indication.Although family members are encouraged to visit,their presence around the clock is not necessary at this point.

Question 2

An older adult client is suspected of being neglected by the caregiver.What assessment provides the nurse with the best information about this possibility?

Accepted Answer

Neglect is often manifested by dehydration,undernutrition,pressure ulcers,or contractures.Injuries raise the suspicion for abuse,whereas disorientation and rapid heart rate/high blood pressure can be the result of disease processes.Noting the client's weight trend would be a helpful assessment related to this suspicion.

Question 3

Which intervention would best support a client who relates a feeling of "loss of control" after having a mild stroke?

Accepted Answer

Older adults can experience various losses that affect their sense of control over their lives,including a decrease in physical mobility.The nurse should support the client's self-esteem and increase feelings of competency by encouraging activities that assist in maintaining some degree of control,such as participation in decision making and performing tasks that he or she can manage.Obtaining an order for therapy evaluations is a normal part of the rehabilitation process.The other choices imply that the client's sense of loss is abnormal after a stroke.

Question 4

An older client is agitated and develops new-onset confusion on admission to the long-term care unit.What is the best action for the nurse to take to minimize relocation stress syndrome for this client?

Accepted Answer

Many nursing interventions can prove helpful to older adults who experience relocation stress syndrome.If the client becomes confused,agitated,or combative,the nurse should reorient the client to his or her surroundings.The nurse also can encourage family members to visit often,keep familiar objects at the client's bedside,and work to establish a trusting relationship with the client.

Question 5

What will the nurse teach the older client with hypertension who complains that "food does not taste good without salt"?

Accepted Answer

Physical changes associated with aging can affect the intake of nutrients.Diminished senses of taste and smell,particularly a decline in the ability to taste sweet and salty,may lead the older adult to overuse sugar and salt.In such cases,the nurse should recommend that the client use herbs and spices to season food.

Question 6

An older adult client is in physical restraints.Which intervention by the nurse is the priority?

Accepted Answer

The application of restraints can have serious consequences.Thus,the nurse should check the client every 30 to 60 minutes,releasing the restraints every 2 hours for positioning and toileting.The other answers would not be appropriate because the client would not be assessed frequently enough,and circulation to the limbs could be compromised.Assessing every hour and releasing the restraints every 2 hours is in compliance with federal policy for monitoring clients in restraints.

Question 7

An older adult client has become agitated and combative toward health care personnel on the unit.What is the first action that the nurse will take?

Accepted Answer

The nurse should establish a trusting relationship with the client,soothe the client's fears,and reorient the client to the facility before resorting to physical or chemical restraints.Restraints,both physical and chemical,may be overused in certain situations.Sedative-hypnotic drugs may have adverse effects in older adults and should be used sparingly.Physical restraints also can have serious repercussions.Transfer to a mental health facility requires evaluation by psychiatric staff and may not be appropriate here.

Question 8

An older adult client is in the hospital.To what government resource would the nurse refer the client to help meet the cost of health care?

Accepted Answer

Medicare is a federal insurance program designed to assist older adults to meet the cost of health care in the hospital.Medicare Part B covers a certain percentage of outpatient services and is paid for by the older adult.Preferred provider organizations and health maintenance organizations are private providers of health care.

Question 9

What conditions predispose an older adult client to acute confusion or delirium?

Accepted Answer

Alcoholism and increased pain and disability more commonly lead to depression.Multi-infarct cerebrovascular disease is associated with progressive dementia.Infection,imbalanced electrolytes,and drug therapy changes are likely to cause acute confusion.

Question 10

An older adult client is being discharged from the hospital on several medications.Which intervention best reinforces medication teaching for this client?

Accepted Answer

Supervised self-administration of medications allows accurate assessment of the client's capabilities and hands-on learning opportunities for instruction or reinforcement.

Question 11

An older adult client's spouse has died,and the family expresses concern that the client has lost weight recently and now refuses to attend the annual family reunion.The nurse should assess this client further for what clinical condition?

Accepted Answer

Situational depression can result after a loss and is defined as a mood disorder with cognitive,affective,and physical symptoms.Dementia is characterized by a gradual decline in intellectual functioning that is chronic and progressive compared with delirium,which is an acute state of confusion that is short term and reversible.Psychosis is a mental health problem that usually is not driven by loss.

Question 12

A nurse manager is planning a comprehensive care plan for older clients admitted to the medical-surgical unit.To decrease hospital stays and lessen the pain that older clients experience,which standard intervention should the manager include in the care bundle for this population?

Accepted Answer

All actions would be important parts of a care bundle for older adult clients admitted to a hospital.However,depression is the most common mental health/behavioral health problem among older adults in the community.Early detection can prevent the effects of depression,including worsening of medical conditions,increased pain and disability,and delayed recovery from illness.Failure to diagnose and treat depression can result in risk of physical illness,alcoholism,and suicide.

Question 13

A nurse is assessing a client's understanding of medication therapy.Which statement indicates that the client needs further instruction?

Accepted Answer

Changing the dose of medication without a correct understanding of the drug's use and appropriate schedule can cause serious problems.The other statements indicate good understanding of self-administering medications.

Question 14

An older adult recently had a hysterectomy and has requested some medication for pain.The physician leaves an order for meperidine (Demerol).Which action by the nurse is most appropriate?

Accepted Answer

Meperidine (Demerol)is included among the Beers criteria for potentially inappropriate medication use in older adults.Morphine,codeine,and hydromorphone are acceptable medications for the older adult that the nurse could suggest to the physician.Assessing the client's pain and monitoring respiratory rate are important interventions for any client receiving narcotic analgesics,but in this case,client safety is best ensured by not administering inappropriate drugs.Iron supplements can be administered without regard to Demerol.

Question 15

An older adult client has been admitted to a skilled nursing facility following surgery.What interventions should the nurse add to this client's care plan to assist with adjusting to this situation? (

Accepted Answer

An anxiolytic may increase the difficulty that the client has in interpreting new surroundings.Encouraging the client to eat alone and setting a daily schedule for the client discourages decision making about activities of daily living.Making sure that the client can see and hear will help in environmental interpretation,familiar possessions will provide a sense of identity,and having some input into the organization of his or her immediate surroundings helps develop a sense of control.

Question 16

Which behavior exhibited by an older adult client alerts the nurse to the possibility that the client is experiencing delirium?

Accepted Answer

Delirium is characterized by acute confusion that is usually short term.Delirium can result from placement in unfamiliar surroundings,such as being hospitalized.Depression is characterized by an increase in sleep and lack of social contact.Slurred speech may indicate a stroke.

Question 17

A client with Alzheimer's disease has been hospitalized for dehydration.In making an assessment,the nurse notes the presence of a cluster of bruises on the client's buttocks.What is the nurse's priority action?

Accepted Answer

If a nurse suspects elder abuse or neglect,the nurse notifies the physician and the social worker to begin an investigation of the situation.

Question 18

An older adult client presents with signs and symptoms related to digoxin toxicity.Which age-related change may have contributed to this problem?

Accepted Answer

Decreased renal blood flow and reduced glomerular filtration can result in slower medication excretion time,potentially leading to toxic drug accumulation.Aging results in decreased total body water and gastrointestinal motility and an increase in the ratio of adipose tissue to lean body mass,but is not related to digoxin toxicity.

Question 19

A nurse is caring for an older adult client who lives alone.Which economic situation presents the most serious problem for this client?

Accepted Answer

Older adults on fixed incomes are unable to adjust their income to meet rising costs associated with meeting basic needs.

Question 20

A nurse is assessing a client at risk for dehydration.Which statement by the client indicates that more education by the nurse is required?

Accepted Answer

Older adults have less body water than younger adults.It is recommended that the older client drink at least six glasses of water each day to avoid dehydration.Caffeine and alcohol intake can stimulate more loss of fluid from the body,further increasing the risk for dehydration.The older client needs to continue to drink fluids throughout the day and should not limit fluids because of mobility problems,diuretic use,or incontinence.

Quiz 3: Common Health Problems of Older Adults