Deck 26: The Older Adult Patient

Question 1

When the nurse is taking a nursing history on a patient,the patient mentions,"I slipped on a wet spot on the way to the bathroom." Which of the following is a priority for the nurse to ask?

A) "Have you been feeling excessively weak recently?"
B) "Do you drink caffeinated beverages?"
C) "Have you started on any new medications?"
D) "Have you experienced any incontinent episodes?"

Answer 1

"Have you experienced any incontinent episodes?"

Question 2

When interviewing the elderly patient,all of the following techniques will be helpful,EXCEPT

A) allowing extra time for the interview.
B) scheduling more than one interview.
C) speaking loudly and slowly.
D) interviewing a family member or caregiver as well as the patient.

Answer 2

speaking loudly and slowly.

Question 3

A 93-year-old patient has been functioning independently in the home but has suddenly become confused.A family member asks the nurse,"Does this mean Dad has Alzheimer's disease?" Which of the following is the most appropriate response?

A) "Your father will have to be monitored over time."
B) "It is very likely your father has Alzheimer's disease."
C) "Why do you think your father has dementia?"
D) "Confusion can be a sign of an infection in an older adult."

Answer 3

"Confusion can be a sign of an infection in an older adult."

Question 4

When assessing an older adult,the nurse should be alert to the clinical manifestations of depression that may be masked by other chronic conditions.The cardinal and primary behavior exhibited in the depressed older adult is

A) loss of appetite and weight loss.
B) drinking alcohol.
C) loss of interest in previously pleasurable activities.
D) inactivity.

Question 5

Which of the following patients is most at risk for developing delirium?

A) 50-year-old woman with cholecystitis
B) 19-year-old man with a fractured femur
C) 42-year-old woman having an elective hysterectomy
D) 78-year-old man admitted to an intensive care unit with complications of congestive heart failure

Question 6

All of the following can normally be present in the aging adult,EXCEPT

A) decreased memory, especially short-term memory.
B) increased visual acuity.
C) diminished amounts of neurotransmitters.
D) diminished total brain weight.

Question 7

One of the many changes in the skin resulting from aging is senile lentigo,or liver spots,which are caused by

A) decreased vasodilation and vasoconstriction of the dermal arterioles.
B) thinning epidermis and loss of subcutaneous fat.
C) overgrowth of the horny layer.
D) inability of the melanocytes to produce an even pigmentation of the skin.

Question 8

Which of the following is most likely to indicate pathological changes of the respiratory system rather than changes resulting from the aging process?

A) barrel chest
B) pursed-lip breathing
C) diminished cough reflex
D) loss of alveolar gas exchange

Question 9

Presbyopia occurs in older individuals because

A) the macula degenerates.
B) the lens becomes more dense.
C) of the development of glaucoma.
D) it is associated with cataract development.

Question 10

The impact that older adults have on the health care system is illustrated by the fact that

A) the aging population is growing faster than any other age group.
B) many individuals over age 65 have chronic illnesses requiring frequent hospitalizations.
C) older adults have a lower rate of hospitalization and physician visits than any other group.
D) older adults tend to overreport symptoms and delay seeking treatment.

Question 11

Which of the following four older adults that the nurse is caring for does the nurse evaluate as most at risk for self-directed violence (suicide)?

A) recently widowed woman with multiple chronic illnesses who lives near family
B) widowed man who is 88 years old, lives alone, and has multiple chronic illnesses
C) 76-year-old single man who lives in a retirement center and engages in community activities
D) 83-year-old woman who has type 2 diabetes mellitus and lives with her daughter

Question 12

An older adult may complain of difficulty driving at night.Which physiological change in the eye can explain this problem?

A) The pupils become smaller.
B) Peripheral vision widens.
C) Accommodation is increased.
D) The ability to discern the colors red and green is impaired.

Question 13

Enlargement of the prostate in benign prostatic hypertrophy may also be associated with

A) urinary obstruction.
B) frequent sexual activity.
C) smoking.
D) overstimulation of alpha-1 adrenergic receptors.

Question 14

The elderly patient may experience a decrease in height resulting from

A) muscle atrophy.
B) loss of bone density.
C) a narrowing of the intervertebral disk.
D) thoracic kyphosis.

Question 15

A member of an older patient's family asks the nurse why medications are ordered at half of the usual dose.Which of the following is the most appropriate response?

A) "Medications for the older adult are prescribed at a pediatric dose."
B) "The metabolism of the older adult is much like that of a child of the same weight."
C) "Medications for the older adult are sometimes at lower doses initially until the patient's response is evaluated."
D) "Older adults generally take a lower dose of a medication because of cost."

Question 16

A 73-year-old patient has just undergone a colostomy for cancer of the colon.The patient tells the nurse the pain is "8" on a scale of 1 to 10.Which of the following is the expected outcome of the nursing care for this patient?

A) The patient states the pain is "4" on a scale of 0 to 10.
B) The patient verbalizes satisfaction with the level of pain and pain control.
C) The patient does not ask for pain medication.
D) The patient self-medicates with an over-the-counter medication.

Question 17

When evaluating the blood pressure of an older adult,the nurse needs to know that

A) systolic blood pressure decreases and diastolic pressure increases with aging.
B) blood pressure should decrease with age because of decreased heart rate and cardiac output.
C) systolic and diastolic blood pressure tend to rise with aging because of the loss of elasticity of the arteries.
D) dilation of the aorta and rigid arterial pulses make the blood pressure more difficult to measure accurately.

Question 18

Assessment of the muscle strength of older adults cannot be compared with that of younger adults because

A) stroke is more common in older adults.
B) nutritional status is better in younger adults.
C) young people exercise more than older adults.
D) aging leads to a decrease in muscle bulk and strength.

Question 19

Which finding is abnormal in an elderly female?

A) small, flat nipples
B) granular breast tissue upon palpation
C) bilateral tenderness
D) firm, stringy ductal tissue around the nipple

Question 20

Mrs.H,70 years old,complains of discomfort in her pelvic area.Your assessment of Mrs.H reveals pale color and dryness of the vaginal introitus,which most likely indicates

A) atrophy related to the aging process.
B) atrophy related to hormone replacement therapy.
C) bacterial infection.
D) viral infection.

Question 21

Depression is often caused by decreases in the neurotransmitters ____________________ and _____________________.

Question 22

Which of the following contribute to kidney shrinkage and a decrease in glomerular filtration rates? Select all that apply.

A) Glomerular degeneration
B) Thickening of glomerular and tubular basement membranes
C) Decreased length of proximal and distal tubes
D) Enhanced ability to dilute
E) Increased urine concentration
F) Decreased renal blood flow

Question 23

A 70-year-old man presents with a pearly white lesion on his cheek.He tells the nurse that he used to work in the construction industry building houses.The lesion has become itchy and bleeds.What disorder would the nurse suspect this patient has?

A) malignant melanoma
B) squamous cell carcinoma
C) actinic keratosis
D) basal cell carcinoma

Question 24

An effective tool for objectively assessing delirium is the __________________________________.

Question 25

In addition to a change in medication regimen,what other factors might contribute to delirium in the older adult? Select all that apply.

A) Intracranial hemorrhage
B) CNS damage
C) Infection
D) Cranial lesions
E) Metabolic abnormalities
F) Leakage of spinal fluid

Question 26

An 80-year-old man has been experiencing fecal incontinence.Which of the following is the most likely cause of this disorder?

A) denervation of the sensory receptors in the muscles surrounding the rectum
B) increase in the tone of the internal anal sphincter
C) decline in the large bowel transit
D) decrease in intestinal mobility and absorption

Question 27

Mrs.W expresses concern about her 77-year-old husband,stating,"His mind seems to be going.He can't remember where he puts things." Which of the following assessment tools would you administer to obtain further data on his cognitive functions?

A) Beck Depression Inventory (BDI)
B) Folstein Mini Mental Status Examination (MMSE)
C) Katz Index of Independence in Activities of Daily Living
D) Recent Life Changes Questionnaire

Question 28

Normal effects of aging on spermatogenesis include which of the following? Select all that apply.

A) Spermatogenesis occurs in men until about 70 years of age.
B) Sexual desire diminishes.
C) The ability to maintain an erection is enhanced.
D) Sperm output is slightly decreased.
E) Sperm count and motility decline.
F) Impotence.

Question 29

An ethnic older adult may experience a loss of self-worth when the nurse

A) informs the patient about ethnic support services.
B) allows a patient to rely on ethnic health beliefs and practices.
C) has to use an interpreter to provide explanations and teaching.
D) emphasizes that a therapeutic diet does not allow ethnic foods.

Question 30

An older adult patient receives a gift of boxed chocolate candy.The patient has dementia and does not understand that it is candy and it belongs to her.Which of the following actions by the nurse is most appropriate?

A) Tell her that it belongs to her and offer her a piece.
B) Offer the candy to the other patients.
C) Send the candy home with her family.
D) Throw the candy away because she is unable to eat it.