Question 1

A 70-year-old woman complains, I weigh exactly the same as I did when I wore a size 10 and now I can barely squeeze into a size 16. Which statement by the nurse would most correctly explain the size change to the woman?

Accepted Answer

As people age, they tend to lose muscle mass and gain fat mass. This happens because the body's ability to build and maintain muscle decreases with age, while the body's ability to store fat remains relatively unchanged. Therefore, the size change is likely due to a decrease in muscle mass being replaced with adipose tissue.

Question 2

Why would a nurse lead a group of postmenopausal women on a daily 15-minute walking tour through the long-term care facility?

Accepted Answer

Walking is a weight-bearing exercise that can improve bone strength in postmenopausal women, who are at increased risk for osteoporosis. It also has additional benefits for overall physical and mental health. Leading the group on a daily walking tour can encourage consistency and camaraderie among the participants.

Question 3

Why does the nurse modify the environment to keep it warmer for the older adult?

Accepted Answer

As adults age, they tend to lose subcutaneous fat which can lead to increased sensitivity to ambient temperature changes. Thus, keeping the environment warmer can help prevent hypothermia and maintain comfort for the older adult.

Question 4

A person with Parkinsons disease has a nursing diagnosis of nutrition, less than body requirements related to difficulty swallowing. What change would the nurse make in the nursing care plan?

Accepted Answer

Offering a thick, high-nutrition shake as a snack would be the best choice for a patient with difficulty swallowing because it provides important nutrients and can be easier to swallow than solid food. Feeding the patient at each meal or placing the patient in a semi-Fowler position may not address the underlying difficulty swallowing issue. Encouraging the patient to drink water after each bite of solid food may be helpful, but offering a shake as a snack would provide more comprehensive nutrition.

Question 5

What is a cause of pernicious anemia?

Accepted Answer

Pernicious anemia is caused by a deficiency of vitamin B12, which is needed for the production of healthy red blood cells. Without enough vitamin B12, red blood cells become underdeveloped and cannot function properly, leading to anemia.

Question 6

What would be an acceptable alteration in the plan of care for a patient with a hiatal hernia who is experiencing gastrointestinal reflux?

Accepted Answer

Eating smaller, more frequent meals can be helpful for patients with a hiatal hernia and gastrointestinal reflux because it reduces the amount of food in the stomach at one time, which can decrease the likelihood of reflux. Lying down after meals, drinking large amounts of liquid after meals, and using caffeine drinks can all exacerbate reflux symptoms.

Question 7

The Certified Nursing Assistant (CNA) caring for an older adult asks if the yellow, waxy, crusty lesions on the patient s axilla and groin are contagious. Which response shows the nurse s understanding for the cause of the lesions?

Accepted Answer

Seborrheic dermatitis is a non-contagious, inflammatory skin condition caused by excessive sebum production. It is characterized by yellow, waxy, crusty lesions that commonly appear in the axilla and groin. Cellulitis is a bacterial infection that can be contagious, but does not typically present with waxy lesions. Scabies is a contagious skin condition characterized by intense itching and a pimple-like rash, but does not usually present with waxy lesions. Basal cell carcinoma is a type of skin cancer that can present with a variety of lesions, including waxy or pearly bumps, but would not typically be located in the axilla or groin.

Question 8

How should the nurse provide written discharge instructions for a patient with macular degeneration?

Accepted Answer

Patients with macular degeneration often have difficulty with central vision, but may still have functioning peripheral vision. Adjusting the table and light can help the patient to use their peripheral vision to read the written instructions. Writing in bold print or placing the document directly in front of the patient may not be effective if they are unable to use their central vision to read. Reading the document to the patient is not necessary if they are able to use their peripheral vision to read.

Question 9

The nurse assesses a patient with diabetes and finds the patient to be pale, edematous, and listless with a blood urea nitrogen (BUN) level of 35 mg/dL and a creatinine level of 4 mg/dL. What would the results of the nursing assessment indicate?

Accepted Answer

The patient's pale and edematous appearance, along with the elevated BUN and creatinine levels, are indicative of chronic kidney disease. Diverticulitis and benign prostatic hypertrophy are not commonly associated with these findings, and although congestive heart failure may cause edema, it would not typically cause elevated BUN and creatinine levels.

Question 10

The nurse cautions the Certified Nursing Assistants (CNAs) to use care when transferring or handling older adults. The nurse understands that the vascular fragility of the older adult can result in which condition?

Accepted Answer

Senile purpura is a condition in which the skin bruises easily due to the vascular fragility of the skin's blood vessels. This can occur as a result of minor trauma or bumping, and is more common in older adults. Thus, CNAs must be careful when transferring or handling older adults to avoid causing senile purpura. Altered blood pressure, pressure ulcers, and pruritus are conditions that may also affect older adults but are not directly related to vascular fragility.

Question 11

What are Heberden nodes?

Accepted Answer

Heberden nodes are bony enlargements of the distal joints of the fingers, specifically at the DIP (distal interphalangeal) joints. They are commonly seen in osteoarthritis.

Question 12

A 70-year-old woman asks, How in the world can my bones be brittle when I eat all the right foods? Which response by the nurse would be the most informative?

Accepted Answer

Calcium is continuously withdrawn from bones to maintain essential functions such as nerve transmission and muscle contraction, which can lead to bone brittleness over time, especially if not adequately replenished.

Question 13

Which care plan modification would be the most beneficial for a 62-year-old woman who is suffering from a flare in her rheumatoid arthritis?

Accepted Answer

Rest is especially important during flare-ups of rheumatoid arthritis in order to reduce inflammation and prevent further joint damage. Increasing fluid intake and reducing salt in the diet can be helpful for overall health but are not specific modifications for managing a flare. Rigorous finger extension exercises may actually worsen joint pain and inflammation during a flare.

Question 14

Which assessment finding is the cardinal signs and symptoms of congestive heart failure?

Accepted Answer

Dyspnea (shortness of breath) and edema (swelling) are the typical cardinal signs and symptoms of congestive heart failure.

Question 15

What is the pathophysiology of a myocardial infarct?

Accepted Answer

A myocardial infarct occurs when there is a blockage in the coronary arteries, leading to a lack of oxygen supply to the heart muscle. This results in ischemia and eventually necrosis of the affected myocardial tissue. The necrotic tissue is replaced by non-functional scar tissue, which can lead to decreased cardiac function and possible heart failure. Narrowing of the coronary arteries can contribute to the formation of blood clots, which may further block blood flow to the heart and worsen the infarct. Pain is a common symptom of myocardial infarction and is caused by the ischemic myocardium. While some regeneration of myocardial tissue may occur, it is not sufficient to overcome the damage inflicted by the infarct. The damage to the myocardium can lead to serious alterations in cardiac output and increase the risk of complications such as arrhythmias and heart failure.

Question 16

What would be the most helpful response to a 70-year-old postmenopausal woman who asks whether her hormone replacement therapy (HRT) will prevent bone loss?

Accepted Answer

HRT can help prevent bone loss in postmenopausal women by compensating for the decrease in estrogen, which is crucial for maintaining bone density. However, it's important to balance this benefit against the increased risks of stroke, heart attack, and breast cancer associated with HRT, especially in older women.

Question 17

What is the pathophysiology of emphysema?

Accepted Answer

Emphysema is characterized by overinflation of the alveoli, causing them to become less effective in gas exchange. This results from destruction of the walls of the alveoli, typically due to smoking, which leads to loss of elasticity and destruction of the air sacs. Constriction of the bronchial tree, excessive mucus, and coughing are more typical of asthma or chronic bronchitis. Calcification of the alveoli is not a feature of emphysema or any other respiratory disease.

Question 18

A 75-year-old male is worried that his wartlike dark macules with distinct borders are melanomas. What would be the most likely cause for the macules?

Accepted Answer

Seborrheic keratoses are common, benign, wart-like growths that appear in older adults. They have a characteristic "stuck-on" appearance and can vary in color. They are not cancerous and are a more likely cause of the described macules than melanoma.

Question 19

A person who experienced a hemorrhagic cardiac vascular accident (CVA) to the left hemisphere would demonstrate which type of symptoms?

Accepted Answer

A hemorrhagic CVA to the left hemisphere typically results in language disturbances, such as difficulty with speaking or understanding language. This is because the left hemisphere of the brain is typically responsible for language processing. Poor impulse control, inappropriate affect, and confabulation are more commonly associated with damage to the frontal lobes of the brain.

Question 20

The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. What factor is related to heat intolerance in the older adult?

Accepted Answer

As older adults age, their ability to perspire decreases, which makes them more susceptible to heat-related illnesses such as heat prostration. A reduction in the body's ability to regulate temperature can also occur with age. Melanin and capillary fragility are not directly related to heat intolerance in older adults.

Quiz 3: Physiologic Changes