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?

Accepted Answer

Although asking patients if they have started on any new medications,drink caffeinated beverages,or are excessively weak are relevant when taking a health history,the possibility of incontinence is significant given that the patient stated that the fall was the result of "slipping on a wet spot."

Question 2

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

Accepted Answer

Interviewing the older patient may require additional time for question interpretation and patient responses.It may be necessary to schedule more than one interview because the patient may have multisystem changes or complaints,a weakened physical condition,or a cognitive impairment.It may be necessary to interview an older patient's family member or caregiver to assess the patient's past and present health or illness status.Speaking loudly and slowly is not helpful.

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?

Accepted Answer

An older adult patient who suddenly becomes confused may have developed an infection,generally of the lungs and bladder,or may be dehydrated.Confusion that occurs in delirium,Alzheimer's disease,and other forms of dementia develops slowly and over time.Telling the family that the patient may have dementia and will have to be monitored over time shuts down communication.Telling the family that the acute confusion may be a sign of infection keeps communication open and offers information.Rather than a "why" question,the nurse could ask for more recent history on the patient,such as whether he has experienced a fall or head injury.

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

Accepted Answer

Loss of interest in previously enjoyable activities and withdrawal are indicators to the nurse that the patient may be clinically depressed and in need of further assessment.Loss of appetite,weight loss,drinking alcohol,and inactivity are not the primary behaviors exhibited in depressed older adults.

Question 5

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

Accepted Answer

Delirium is a state of temporary acute mental confusion,disorientation,and incoherence which is common in older adults.It is often caused by an interaction of the patient's underlying condition with a precipitating event.Conditions that can precipitate delirium include hospitalization (e.g.,intensive care unit),change in environment,and absence of time and place cues (e.g.,watch,clock).A 78-year-old man admitted to an intensive care unit with complications of congestive heart failure is most at risk for developing delirium.

Question 6

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

Accepted Answer

With aging,visual acuity is decreased,not increased.There is a slight decline in short-term memory in the aging adult.Additionally,the amount of neurotransmitters produced in the neuron is diminished,and the activity of the enzymes that degrade the neurotransmitter increases.Thus,there is a diminished amount of neurotransmitters.The total brain weight,the number of synapses,and the number of neurons diminish with aging,beginning at age 50.

Question 7

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

Accepted Answer

Senile lentigo,or liver spots,are irregular,flat,deeply pigmented macules that appear in sun-exposed areas of the body.They result from the inability of melanocytes to produce even pigmentation of the skin.With aging there is an increased incidence of hypothermia resulting from vasodilation and vasoconstriction of dermal arterioles and loss of subcutaneous fat.Thinning epidermis and loss of subcutaneous tissue over bony prominences increases the risk of skin breakdown.Keratosis,lesions of the epidermis characterized by overgrowth of the horny layer,is prevalent among the older population.

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?

Accepted Answer

Pursed-lip breathing is performed by patients who need to prolong the expiration phase of the respiratory cycle.This type of breathing is performed by patients with COPD.It is the patient's innate mechanism to apply positive-pressure breathing to prevent total alveolar collapse with every breath.Barrel chest,diminished cough reflex,and loss of alveolar gas exchange are changes resulting from the aging process.

Question 9

Presbyopia occurs in older individuals because

Accepted Answer

Presbyopia is a condition where the lens cortex becomes more dense,compromising its ability to change shape and focus on near objects; it is responsible for farsightedness.The macula degenerates with age,causing loss of central vision.Individuals experiencing this change require the use of magnification to compensate for visual loss.Increased intraocular pressure and inability of aqueous humor to flow out into collecting channels places pressure on the optic nerve and causes glaucoma.Cataracts cause progressively blurred distance vision.

Question 10

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

Accepted Answer

In the last 30 years the older adult population (those 65 years of age and older)has grown twice as fast as the rest of the population.The group most rapidly increasing in numbers is those individuals over 85 years old.Many individuals over age 65 do have chronic illnesses.The diagnosis and acute phases of a chronic illness are usually managed in a hospital; however,all other phases of a chronic illness are usually managed at home.The older population,having lived through a number of hardships and life experiences,may erroneously attribute specific symptoms to normal aging,will ignore them,and delay seeking treatment.They tend to underreport symptoms and to treat these symptoms by altering functional status.

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)?

Accepted Answer

Older women,even if depressed,tend to be less likely to harm themselves because they often have social support and other interests.Older men with social supports,other interests,and multiple chronic illnesses are not likely to commit suicide.Older men without social support who have multiple chronic illnesses and live alone are more likely to commit suicide than older women.Therefore,the widowed man in option "b" is most at risk for self-directed violence (suicide).

Question 12

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

Accepted Answer

The pupils become smaller during the aging process; therefore,the amount of light reaching the retina is reduced.As a consequence,the eyes of the older adult take longer to accommodate to darkness and glare,making it more difficult to drive at night.Peripheral vision decreases,and the ability to discern colors is impaired (especially blues and greens).

Question 13

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

Accepted Answer

Benign prostatic hypertrophy (BPH)is related to aging.The prostate capsule may contract and prostatic urethral tone may increase,resulting in urinary obstruction.Frequent sexual activity,smoking,and overstimulation of alpha-1 adrenergic receptors are not related to enlargement of the prostate.

Question 14

The elderly patient may experience a decrease in height resulting from

Accepted Answer

The elderly patient may experience a decrease in height resulting from a narrowing of the intervertebral disk.Height may be diminished by 1.5-3 inches.Muscular atrophy leads to a decrease in muscle mass,strength,and agility.Bone density decreases in the older adult because of an increased rate of reabsorption which exceeds the rate of bone replenishment.This leads to an increased potential for fractures due to osteoporosis.Thoracic kyphosis causes a change in the center of gravity,making the individual more prone to loss of balance and to falls.

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?

Accepted Answer

Age-related changes alter the pharmacodynamics and pharmacokinetics of drugs.Older adults do not metabolize medications at the same rates as children and younger adults.There is a decrease in liver and hepatic mass as well as blood flow that alters drug metabolism and clearance.The most appropriate response is that medications for older adults may be started at a lower dose initially until their response to the drug is evaluated.The dosage will then be adjusted accordingly.The responses in options "a," "b," and "d" are inappropriate.

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?

Accepted Answer

An older adult in severe pain may not ask for pain medication because of a reluctance to "complain." The nurse cannot determine for the patient what is an acceptable level of pain.A good outcome is achieved when the patient can verbalize satisfaction with the level of pain and pain control.

Question 17

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

Accepted Answer

Blood pressure is the pressure exerted by the circulating volume of blood on the walls of the arteries and veins.Both systolic and diastolic blood pressures tend to rise in the older adult because of the loss of elasticity in the arteries.The arterial system becomes increasingly rigid as the blood vessels become fibrotic.A decrease in the diastolic pressure is seen more frequently in older adults with risk factors for hypotension.Blood pressure is not related to heart rate or cardiac output.In the older adult the resting heart rate remains constant,but maximal heart rate declines.The aorta becomes dilated and the arteries become rigid with aging; however,these changes do not 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

Accepted Answer

With age,muscle fibers deteriorate and are replaced by fibrous connective tissue.Muscle atrophy is accompanied by a reduction in muscle mass,a loss of muscle strength against resistance,and a reduction in overall body mass.Although stroke is more common in older adults,this is not associated with muscle strength.Nutritional status is usually better in younger adults,and young people tend to exercise more than older adults.However,neither of these factors is related to the inability to compare muscle strength of older adults with younger adults.

Question 19

Which finding is abnormal in an elderly female?

Accepted Answer

The breasts do not become more tender with aging; however,the nipples become smaller and flatter.The glandular tissue gradually decreases with age,and the breasts feel granular instead of lobular.Ductal tissue becomes more palpable,especially around the nipples,and may become firm and stringy.

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

Accepted Answer

The vaginal introitus constricts as a result of atrophy related to the aging process.This results in a pale color and dryness of the vaginal introitus.Other possible etiologies include atrophy from topical steroids and estrogen deficiency.Atrophy related to hormone replacement therapy and bacterial and viral infections are not the cause of the patient's complaints and symptoms.

Quiz 26: The Older Adult Patient