JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK, Exams of Nursing

Download JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK and more Exams Nursing in PDF only on Docsity! JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK 1. An older adult patient has developed acute confusion. The patient has been on tranquilizers for the past week. The patient’s vital signs are normal. What should the nurse do? Take into account age-related changes in body systems that affect pharmacokinetic Increase the dose of tranquilizer if the cause of the confusion is an infection. Note when the confusion occurs and medicate before that time. Restrict telephone usage to prevent further confusion. ANS: A Sedatives and tranquilizers sometimes prescribed for acutely confused older adults sometimes cause or exacerbate confusion. Carefully administer drugs used to manage confused behaviors, taking into account age-related changes in body systems that affect pharmacokinetic activity. When confusion has a physiological cause (such as an infection), specifically treat that cause, rather than the confused behavior. When confusion varies by time of day or is related to environmental factors, nonpharmacological measures such as making the environment more meaningful, providing adequate light, etc., should be used. Making telephone calls to friends or family members allows older adults to hear reassuring voices, which may be beneficial. JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK DIF: Apply REF: 185-186 OBJ: Describe selected health concerns of older adults. TOP: Implementation MSC: Health Promotion and Maintenance 2. Which of these assessments of an older adult, who has a urinary tract infection, requires an immediate nursing intervention? Presbycusis Confusion Death of a spouse 3 months ago Temperature of 97.6° F ANS: B Confusion is a common manifestation in older adults with urinary tract infection; however, the cause requires further assessment. There may be another reason for the confusion. Confusion is not a normal finding in the older adult, even though it is commonly seen with concurrent infections. Difficulty hearing, presbycusis, is an expected finding in an older adult. Coping with the death of a spouse is a psychosocial concern to be addressed after the acute physiological concern in this case. Older adults tent to have lower temperatures, so the nurse needs to assess for slight elevations. A temperature of 97.6° F is within normal limits. DIF: Apply REF: 175| 178-179 OBJ: Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging. TOP: Planning MSC: Physiological Integrity 3. Which of these patient statements is the most reliable indicator that an older adult has the correct understanding of health promotion activities? “I need to increase my fat intake and limit protein.” “I should discontinue my fitness club membership for safety reasons.” JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK OBJ: Discuss issues related to psychosocial changes of aging. TOP: Assessment MSC: Psychosocial Integrity MULTIPLE RESPONSE 1. A recently widowed 80-year-old male is dehydrated and is admitted to the hospital for intravenous fluid replacement. During the evening shift, the patient becomes acutely confused. The nurse’s best action is to assess the patient for which of the following reversible causes? (Select all that apply.) Electrolyte imbalance Hypoglycemia Drug effects Dementia Cerebral anoxia ANS: A, B, C, E Delirium, or acute confusional state, is a potentially reversible cognitive impairment that is often due to a physiological event. Physiological causes of delirium can include electrolyte imbalances, cerebral anoxia, hypoglycemia, medications, drug effects, tumors, subdural hematomas, and cerebrovascular infection, infarction, or hemorrhage. Unlike delirium, dementia is a gradual, progressive, irreversible cerebral dysfunction. DIF: Apply REF: 176| 179-180 OBJ: Differentiate among delirium, dementia, and depression. TOP: Implementation MSC: Health Promotion and Maintenance 5. As the aging population in the United States increases, the nurse knows that the a Baby boomer generation accounts for a very small percentage of this group. JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK b Extension of the average life span has also increased. c Population segment over age 85 is decreasing. d Diversity of this age group will certainly decrease. ANS: B According to estimates, the number of older adults will increase to 72.1 million by 2030. Part of that increase is due to extension of the average life span. Two other factors that contribute to the projected increase in the number of older adults are the aging of the baby boom generation and the growth of the population segment over age 85. The baby boomers are the large group of adults born between 1946 and 1964.The diversity of the group over age 65 will also possibly increase. DIF: Remember REF: 171 OBJ: Identify common myths and stereotypes about older adults. TOP: Assessment MSC: Health Promotion and Maintenance 6. As a patient ages, the nursing plan of care a Should be standardized because all geriatric patients have the same needs. b Needs to be individualized to the patient’s unique needs. c Should be based on chronological age alone. d Focuses on the disabilities that all aging persons face. ANS: B JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK Every older adult is unique, and the nurse needs to approach each one as a unique individual. The nursing care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Nurses need to take into account the cultural, JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK “Many older adult patients remain independent enough to live alone.” ANS: A Although many experience chronic conditions or have at least one disability that limits their performance of activities of daily living, in 2004, 37.4% of noninstitutionalized older adults assessed their health as excellent or very good. Older adults do report continued enjoyment of sexual relationships. Although changes in vision or hearing and reduced energy and endurance sometimes affect the process of learning, older adults are lifelong learners. Most older adults live in noninstitutional settings with family members or alone. DIF: Remember REF: 172 OBJ: Identify common myths and stereotypes about older adults. TOP: Assessment MSC: Health Promotion and Maintenance 9. Which teaching strategy is best to utilize with older adult patients? Provide several topics of discussion at once to promote independence and making c Avoid uncomfortable silences after questions by helping patients complete their sta Ask patients to recall past experiences that correspond with their interests. Speak in a high pitch to help patients hear better. ANS: C Teaching strategies include the use of past experiences to connect new learning with previous knowledge, focusing on a single topic to help the patient concentrate, giving the patient enough time in which to respond because older adults’ reaction times are longer than those of younger persons, and keeping the JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK tone of voice low; older adults are able to hear low sounds better than high- frequency sounds. DIF: Understand REF: 173-174 OBJ: Identify selected biological and psychosocial theories of aging. TOP: Implementation MSC: Health Promotion and Maintenance 10. An older patient has fallen and broken his hip. As a consequence, the patient’s family is concerned about his ability to care for himself, especially during his convalescence. What should the nurse do? JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK Stress that older patients usually ask for help when needed. Inform the family that placement in a nursing center is a permanent solution. Tell the family to enroll the patient in a ceramics class to maintain his quality of lif Provide information and answer questions as family members make choices among options. ANS: D Nurses assist older adults and their families by providing information and answering questions as they make choices among care options. Some older adults deny functional declines and refuse to ask for assistance with tasks that place their safety at great risk. The decision to enter a nursing center is never final, and a nursing center resident sometimes is discharged to home or to another less-acute residence. What defines quality of life varies from person to person. Nurses must listen to what the older adult considers to be most important rather than making assumptions about the individual’s priorities. DIF: Remember REF: 174 OBJ: Discuss common developmental tasks of older adults. TOP: Implementation MSC: Health Promotion and Maintenance 11. What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing center? Suggest choosing a nursing center that is as sanitary as possible. The closer the cen hospital standards, the better. Have family members evaluate nursing home staff according to their ability to get t efficiently. Make sure that nursing home staff members get patients out of bed every day for th day. JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK DIF: Apply REF: 174 OBJ: Discuss common developmental tasks of older adults. TOP: Implementation MSC: Health Promotion and Maintenance | Physiological Integrity 13. Several theories on aging have been put forth, and the nurse should use these theories to Guide nursing care. JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK Explain the stochastic view of genetically programmed physiological changes. Select one theory to guide nursing care for all geriatric patients. Understand the nonstochastic views of aging as the result of cellular damage. ANS: A Although theories on aging are in various stages of development and have limitations, the nurse should use them to increase understanding of the phenomena affecting the health and well-being of older adults and to guide nursing care. Stochastic theories view aging as the result of random cellular damage occurring over time. No one single universally accepted theory predicts and explains the complexities of the aging process. Nonstochastic theories view aging as the result of genetically programmed physiological mechanisms within the body. DIF: Apply REF: 173-174 OBJ: Identify selected biological and psychosocial theories of aging. TOP: Implementation MSC: Health Promotion and Maintenance 14. The nurse correctly describes psychosocial theories on aging as theories that Describe role changes in behaviors in older adults. Emphasize that all adults age in similar ways. Stress the need for the aging to discontinue activities as they age. Describe behavior patterns for all aging adults as unpredictable. ANS: A Psychosocial theories of aging explain changes in behaviors, roles, and relationships that come with aging. Although some theories generalize about JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK aging, biologically and psychosocially each individual ages uniquely. The activity theory considers the continuation of activities performed during middle age as necessary for successful aging. The continuity theory states that personality remains the same and behavior becomes more predictable as people age. DIF: Remember REF: 173 JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK Older adults usually are aware and accepting of the aging process. ANS: B Older adults face the necessity of adjustment to the physical changes that accompany aging. As body systems age, changes in appearance and functioning occur. These changes are not associated with a disease but are normal changes. The presence of disease sometimes alters the timing of the changes or their impact on daily life. Acceptance of personal aging does not mean retreat into inactivity, but it does require a realistic review of strengths and limitations. Some older adults find it difficult to accept that they are aging. DIF: Apply REF: 175-176 OBJ: Describe common physiological changes of aging. TOP: Planning MSC: Health Promotion and Maintenance 17. During assessment of an older adult’s skin integrity, expected findings include which of the following? Decreased elasticity Oily skin Increased facial hair in men Faster nail growth ANS: A Loss of skin elasticity is a common finding in the older adult. Other common findings include pigmentation changes, glandular atrophy (oil, moisture, sweat glands), thinning hair (facial hair: decreased in men, increased in women), slower nail growth, and atrophy of epidermal arterioles. DIF: Remember REF: 176 OBJ: Describe common physiological changes of JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK aging. TOP: Assessment MSC: Health Promotion and Maintenance 18. An older adult patient in no acute distress reports being less able to taste and smell. What is the nurse’s best response to this information? Notify the physician immediately to rule out cranial nerve damage. Perform testing on the vestibulocochlear nerve and a hearing test. JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK Schedule the patient for an appointment at a smell and taste disorders clinic. Explain to the patient that diminished senses are normal findings. ANS: D Diminished taste and smell senses are common findings in older adults. Scheduling an appointment at a smell and taste disorders clinic, testing the vestibulocochlear nerve, or an attempt to rule out cranial nerve damage is unnecessary at this time per the information provided. DIF: Apply REF: 176 OBJ: Describe common physiological changes of aging. TOP: Assessment MSC: Health Promotion and Maintenance 19. Which symptom is an expected cognitive change in the older adult patient? Disorientation Slower reaction time Poor judgment Loss of language skills ANS: B Slower reaction time is a common change in the older adult owing to degeneration of nerve cells, decreased neurotransmitters, and decreased rate of conduction of impulses. Symptoms of cognitive impairment, such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgment are not normal aging changes and require further investigation of underlying causes. DIF: Understand REF: 176| 178-179 OBJ: Differentiate among delirium, dementia, and depression. TOP: Assessment MSC: Health Promotion and Maintenance JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK adults see themselves as unattractive and rejected because of changes in their personal appearance due to normal aging changes or because of body image changes. Many communities have outreach programs designed to make contact with isolated older adults. JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK DIF: Understand REF: 180-181 OBJ: Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging. TOP: Implementation MSC: Health Promotion and Maintenance 22. A male older adult patient expresses his concern and anxiety about decreased penile firmness during erection. What is the nurse’s best response? Explain that over time, his libido will decrease, as will the frequency of sexual acti Tell the patient to double his antidepressant medication to increase his libido. Tell the patient that this change is expected in aging adults. Tell the patient that touching should be avoided unless intercourse is planned. ANS: C Decreased firmness during erection is an expected change in aging adults. Libido does not necessarily decrease as one ages. Many older adults use prescription medications that depress sexual activity such as antihypertensives, antidepressants, sedatives, or hypnotics. Touch complements traditional sexual methods or serves as an alternative sexual expression when physical intercourse is not desired or possible. DIF: Apply REF: 180-182 OBJ: Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging. TOP: Implementation MSC: Health Promotion and Maintenance 23. A patient asks the nurse what the term polypharmacy means. The nurse defines this term as JONES COLLEGE: CHAPTER 14: OLDER ADULTS TEST BANK Multiple side effects experienced when taking a medication. The concurrent use of many medications. The many adverse drug effects reported to the pharmacy. The risks of medication effects due to aging. ANS: B Polypharmacy refers to the concurrent use of many medications. It does