Question 1

The nurse is admitting an older-adult client who is hospitalized with an acute illness. Which of the following interventions should the nurse do first?

Accepted Answer

The older adult who moves to a different location needs a thorough orientation to the environment. The nurse should repeatedly reassure the client that he or she is safe and attempt to answer all questions. The unit should foster client orientation by displaying large-print clocks, avoiding complex or visually confusing wall designs, clearly designating doors, and using simple bed and nurse-call systems. Physical or chemical restraints may be necessary, but the nurse's first action should be to provide an ongoing and clear physical orientation. There is no indication that the client needs observation at this time.

Question 2

Which action will the nurse take when planning for discharge of an older-adult client who will need daily assistance with activities such as shopping and transportation?

Accepted Answer

Home health care visits, from an unregulated health care worker, can enable the client to remain at home but obtain assistance with shopping and transportation. Medicare,
assisted-living facilities, and adult day care programs provide funding for specific medical services, but not for needs such as shopping or transportation.

Question 3

Findings from a health history indicate that the client takes daily supplements of the antioxidants beta carotene, vitamin C, and vitamin E. This health practice reflects which of the following theories of biological aging?

Accepted Answer

Free radicals are natural by-products of many normal cellular processes and are also created under the influence of environmental factors such as smog, tobacco smoke, and radiation. Numerous natural protective mechanisms are in place to prevent oxidative damage. Recent research has focused on the roles of various antioxidants, including vitamins C and E, in slowing down the oxidative process and, ultimately, the aging process. The somatic mutation theory focuses on spontaneous mutations. The crosslinking theory is based upon lipids, proteins, CHO, and nucleic acid reactions. The
telomere-telomerase depletion theory focuses on the loss of telomeres, repeated sequences at the ends of DNA.

Question 4

The nurse is providing care to older adults in a Northern outreach clinic. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions?

Accepted Answer

The most information about drug use and possible interactions is obtained when the client brings all prescribed medications, OTC medications, and supplements to every health care appointment. The client should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but use of supplements and herbal medications also need to be considered in order to prevent
drug-drug interactions. Use of a medication schedule will help the client take medications as scheduled but will not prevent drug-drug interactions.

Question 5

Which of the following actions should the nurse consider when developing the plan of care for an older adult who is hospitalized for an acute illness?

Accepted Answer

The plan of care for older adults should be individualized and based on the client's current functional abilities. A standardized geriatric nursing care plan will not address individual client needs and strengths. A client's need for discharge to a long-term care facility is variable. Activity level should be designed to allow the client to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.

Question 6

Which information obtained by the home health nurse when making a visit to a frail older-adult client with mild forgetfulness is of concern?

Accepted Answer

A 4.5 kg weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this client. It is not unusual that an elderly adult would have friends who have died.

Question 7

Which nursing actions will the nurse take to assess for possible malnutrition in an older-adult client? (Select all that apply.)

Accepted Answer

The laboratory results, especially albumin levels, may indicate chronic poor protein intake. Transportation impacts clients' ability to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor condition may decrease the ability to chew and swallow. Food likes and dislikes are not necessarily associated with malnutrition.

Question 8

The nurse is caring for clients in a geriatric family practice clinic with a primary health care provider. Which of the following actions should the nurse do when caring for older adults who live in rural areas?

Accepted Answer

Transportation can be a barrier to accessing health services in rural areas. There are no chronic diseases unique to rural areas. Because medications may change, the nurse should help the client plan for obtaining medications through alternate means such as the mail or delivery services, not by purchasing large quantities of the medications. The client living in a rural area may lose the benefits of a familiar situation and social support by moving to an urban area.

Question 9

The nurse suspects that elder abuse may be occurring when a frail older-adult client with a broken arm is brought to the emergency department by a family member. Which of these actions should the nurse take first?

Accepted Answer

The initial action should be assessment and interviewing of the client. The client should be interviewed alone because the client will be unlikely to give accurate information if the abuser is present. If abuse is occurring, the client should not be discharged home for a later assessment by a home health nurse. The nurse needs to collect and document physiological data before notifying the elder protective services agency.

Question 10

The nurse is admitting an older-adult client who has urinary urgency and a possible urinary tract infection (UTI). Which of the following actions should the nurse implement first?

Accepted Answer

Before beginning the assessment of an older client with a UTI and urgency, the nurse should have the client empty the bladder because bladder fullness or discomfort will distract from the client's ability to provide accurate information. The client may seem disoriented if distracted by pain or urgency. The physical assessment data are obtained after the client is as comfortable as possible.

Question 11

The nurse is admitting an acutely ill older-adult client to the hospital. Which of the following interventions should the nurse implement during the admission process?

Accepted Answer

Assistive devices should be in place before assessing the client to minimize anxiety and confusion. When a client is acutely ill, the physical assessment should be accomplished first to detect any physiological changes that require immediate action. Not all older clients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older clients. To avoid tiring the client, much of the medical history can be obtained from medical records.

Question 12

The home health nurse is caring for an older-adult client who lives alone and is taking seven different prescribed medications for chronic health problems. Which of the following nursing interventions would be most appropriate to ensure medication regimenadherence?

Accepted Answer

Since forgetting to take medications is a common cause of medication errors in older adults, the use of medication reminder devices is helpful when older adults have multiple medications to take. There is no indication that the client needs to move to assisted living or that the client does not understand the importance of medication regimen adherence.
Home health care is not designed for the client who needs ongoing assistance with
activities of daily living (ADLs) or instrumental ADLs (IADLs).

Question 13

The nurse is planning care for an alert and active older-adult client who takes multiple medications for chronic cardiac and respiratory disease and lives with a daughter who works during the day. Which nursing diagnosis is most appropriate?

Accepted Answer

The client's age and multiple medications indicate a risk for injury caused by interactions between the multiple drugs being taken and a decreased drug metabolism rate. The client data do not indicate problems with social isolation, caregiver role strain, or compromised family coping.

Question 14

The nurse is assessing the nutritional status of an older-adult client using the SCALES acronym. Which of the following should the nurse assess when completing the "S"?

Accepted Answer

The acronym SCALES can be used to remind the nurses to assess important nutritional indicators. In the case of the "S," the nurse is to assess sadness or mood changes.

Question 15

The nurse is teaching an older-adult female client about her new medications and the client replies that she "just can't remember all that information anymore." Which of the following changes may interfere with the clients' ability to learn about the new medications?

Accepted Answer

Declining physical health is an important factor in cognitive impairment. Intellectual ability does not decline with age. All mental abilities do not slow as an individual ages. Vocabulary and verbal function do not decrease with age.

Question 16

Which of the following actions would enable the nurse to obtain the most complete information when doing an assessment with an older-adult client?

Accepted Answer

The most complete information about the client will be obtained through the use of an assessment instrument specific to the geriatric population, which includes information about both medical diagnoses and treatments and about functional health patterns and abilities. A review of the chart, interviews of the client and caregiver, and written information by the client will all be included in a comprehensive geriatric assessment.

Question 17

The nurse is visiting a homeless shelter for older adults to provide a health-promotion activity. Which of the following factors are associated with adult homelessness? (Select all that apply.)

Accepted Answer

Key factors associated with homelessness are low income, reduced cognitive capacity, and living alone. There is a shortage of affordable housing and homeless adults generally have an increase in health problems.

Question 18

The nurse is caring for an older-adult client with multiple health problems who states that who reports having "no energy" and feeling increasingly weak. The client has had a 5 kg weight loss over the last year. Which of the following interventions should thenurse implement initially?

Accepted Answer

In the frail elderly client, nutrition is frequently compromised, and the nurse's initial action should be to assess the client's nutritional status. Active range of motion may be helpful in improving the client's strength and endurance, but nutritional assessment is the priority because the client has had a significant weight loss. The client may be a candidate for long-term care placement, but more assessment is needed before this can be determined. The client's assessment data are not consistent with normal changes associated with aging.

Question 19

Which information about an older-adult client who is being assessed by the home health nurse is of most concern?

Accepted Answer

Inactivity and immobility lead rapidly to loss of function in older adults. The nurse should develop a plan to prevent further deconditioning and restore function for the client.
Self-management is appropriate for independently living older adults. The use of three medications is not unusual for an older adult. The use of memory devices to assist with safe medication administration is recommended for older adults.

Quiz 7: Older Adults