Chapter 13: Older Adult Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1 The nurse is performing a physical examination of an older adult client in an assisted living facility. On completion of the exam, the nurse compares the results with findings expected for individuals in this age group. An expected finding for this client is:

a.

Increased tactile responsiveness

b.

Increased sensitivity to glare

c.

Increased hearing acuity for higher tones

d.

Increased thoracic expansion during ventilation

ANS: b

b. A common physiologic change in the older adult client is an increased sensitivity to glare.

a. Increased tactile responsiveness would not be an expected finding in the older adult client.

c. An expected physiologic change in the older adult client is a loss of hearing acuity for high-frequency tones (presbycusis).

d. The older adult has decreased thoracic expansion during ventilation because of musculoskeletal changes.

REF: Text Reference: p. 242

2. A 70-year-old client is to have her blood pressure checked each shift. She asks the nurse to explain her hypertension. An appropriate response by the nurse is that older clients often experience hypertension because of:

a.

Vascular changes and accumulation of plaque on arterial walls, both of which reduce contractility

b.

Reduction in physical activity

c.

Ingestion of processed foods high in sodium

d.

Myocardial damage

ANS: a

a. Although hypertension is not a normal physiologic change of aging, older adults often experience hypertension because of vascular changes and accumulation of plaque on arterial walls, both of which reduce contractility. Vascular changes include thickening of vessel walls, narrowing of vessel lumen, and loss of vessel elasticity.

b. Hypertension is not caused by a reduction in physical activity.

c. Older adults with hypertension should be counseled on limiting fat and salt in their diets. However, ingestion of processed foods high in salt is not the reason that older clients often experience hypertension.

d. Myocardial damage is not the reason for older adults commonly experiencing hypertension.

REF: Text Reference: p. 242

3. In reviewing changes in the older adult, the nurse recognizes that the following statement related to cognitive functioning in the older client is true:

a.

Reversible systemic disorders are often implicated as a cause of delirium.

b.

Cognitive deterioration is an inevitable outcome of aging.

c.

Delirium is easily distinguished from irreversible dementia.

d.

Therapeutic drug intoxication is a common cause of senile dementia.

ANS: a

a. Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as an electrolyte imbalance, cerebral anoxia, hypoglycemia, medications, tumors, cerebrovascular infection, or hemorrhage.

b. Dementia is not an inevitable outcome of aging.

c. Delirium is not always easily distinguishable from irreversible dementia. Because of the close resemblance between delirium and dementia, the presence of delirium must be ruled out whenever dementia is suspected.

d. The cause of senile dementia (i.e., Alzheimers disease) is not known. Medications and drug effects can cause delirium.

REF: Text Reference: p. 244

4. A client has been recently diagnosed with Alzheimers disease. When teaching the family about the prognosis, the nurse must explain that:

a.

It usually progresses gradually with a deterioration of function.

b.

Many individuals can be cured if the diagnosis is made early.

c.

Diet and exercise can slow the process considerably.

d.

Few clients live more than 3 years after the diagnosis.

ANS: a

a. Alzheimers disease usually progresses gradually, with a deterioration in function.

b. No cure is known for Alzheimers disease, but medications can be given to slow the progression of symptoms.

c. Medications, not diet and exercise, can slow the process of Alzheimers disease considerably.

d. Clients may live years after the diagnosis of Alzheimers disease.

REF: Text Reference: p. 244

5. For older adults, a number of health-related concerns should be addressed. The nurse incorporates this information to meet the needs of the older adult client. Which of the following statements accurately reflects data that the nurse should use in planning care?

a.

Approximately 50% of adults older than 65 years have two chronic health problems.

b.

Cancer is the most common cause of death among older adults.

c.

Minimal nutritional needs for older adults are essentially the same as those for younger adults.

d.

Adults older than 65 years make up the highest percentage of users of prescription medications.

ANS: d

d. This is a true statement. Approximately two thirds of older adults use prescription and nonprescription drugs, with one third of all prescriptions being written for older adults.

a. Approximately 90% of adults older than 65 have at least one chronic health condition. Approximately 70% of older adults have multiple chronic conditions with arthritis, hypertension, heart disease, vision impairment, and diabetes mellitus the most common in noninstitutionalized older adults.

b. Heart disease is the leading cause of death in older adults.

c. Nutritional needs of older adults are affected by their levels of activity and by clinical conditions.

REF: Text Reference: p. 252

6. Myths exists regarding the older adult population in the United States. The nurse is aware that the majority of older adults:

a.

Live alone

b.

Live in institutional settings

c.

Are unable to care for themselves

d.

Are active and involved in their community

ANS: d

d. This is a true statement.

a. The majority of older adults live with a spouse or have other living arrangements such as living with a family member.

b. Most older adults live in noninstitutional settings.

c. Most older adults are able to care for themselves.

REF: Text Reference: p. 236

7. The nurse works with elderly clients in a wellness-screening clinic on a weekly basis. Which of the following is the best statement made to clients in the older adult age group?

a.

Your shoulder pain is normal for your age.

b.

Continue to exercise your joints regularly to your tolerance level.

c.

Dont worry about taking that combination of medications because your doctor has prescribed them.

d.

Why dont you begin walking 3 to 4 miles per day, and well evaluate how you feel next week.

ANS: b

b. Clients in the older adult age group should be advised to exercise their joints regularly to their level of tolerance.

a. Shoulder pain is not a normal finding in the older adult. It may indicate a condition such as arthritis.

c. Periodic and thorough review of all medications being used is important to restrict the number of medications used to the fewest necessary. Concurrent use of medications increases the risk for adverse reactions.

d. Exercise programs should begin conservatively and progress slowly.

REF: Text Reference: p. 251

8. A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying:

a.

Dont worry about the medications name if you can identify it by its color and the way it looks.

b.

Please feel free to ask your physician why you are receiving the medications that are ordered for you.

c.

Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications.

d.

Unless you have severe side affects from taking your medications, dont worry about the minor changes in the way you feel.

ANS: b

b. The nurse should encourage the older adult to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs.

a. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs.

c. The hepatic system is not the only system responsible for the pharmacotherapeutics of medication. Older adults are at risk for adverse reactions because of age-related changes in the absorption, distribution, metabolism, and excretion of drugs. Changes in the GI system may affect absorption, distribution may be affected by changes in body composition and by reduced serum albumin levels, and changes in kidney functioning may impair excretion.

d. The nurse should teach the client how to avoid adverse side effects and to report them to the care provider if they occur. If the client is disturbed by minor side effects it could be an indication of beginning drug toxicity. Another possibility is that the client may become noncompliant with the medication because of dislike of how the side effects make him or her feel.

REF: Text Reference: p. 252

9. Not all older adult clients respond well to the physical changes associated with the aging process. Some individuals act to deny the effects of aging by:

a.

Reducing cosmetic use

b.

Spending more time with other older adults

c.

Refusing assistance with certain activities

d.

Exaggerating their actual ages

ANS: c

c. Some older adults may deny functional declines associated with aging and refuse to ask for assistance with tasks that place their safety at great risk.

a. Some older adults find it difficult to accept themselves as aging and attempt to conceal physical evidence of aging with cosmetics.

b. Spending more time with other older adults is indicative of the older adults acceptance of personal aging. Those who find it difficult to accept themselves as aging may avoid activities designed to benefit older adults, such as senior citizens centers and senior health promotion activities.

d. Older adults who find it difficult to accept themselves as aging may understate their age when asked.

REF: Text Reference: p. 239

10. In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging?

a.

Increased perspiration

b.

Increased audio pitch discrimination

c.

Increased salivary secretions

d.

Increased airway resistance

ANS: d

d. Normal physiologic changes of aging include increased airway resistance in the older adult.

a. The older adult would be expected to have decreased perspiration and drier skin because of glandular atrophy (oil, moisture, sweat glands) in the integument system.

b. A normal physiologic change of the older adult related to hearing, is a loss of acuity for high-frequency tones (presbycusis).

c. The older adult would be expected to have a decrease in saliva.

REF: Text Reference: p. 242

11. The nurse recognizes that factors associated with aging influence the musculoskeletal system. The nurse recognizes that:

a.

Older men have a greater problem with osteoporosis.

b.

Muscle fibers increase in size and become tight.

c.

Exercise reduces the loss of bone mass.

d.

Muscle strength does not diminish as much as muscle mass

ANS: c

c. Older adults who exercise regularly do not lose as much bone and muscle mass or muscle tone as do those who are inactive.

a. Postmenopausal women have a greater problem with osteoporosis than do older men.

b. Muscle fibers are reduced in size with aging.

d. Muscle strength diminishes in proportion to the decline in muscle mass.

REF: Text Reference: p. 244

12. The nurse, preparing to discharge an 81-year-old client from the hospital, recognizes that the majority of older adults:

a.

Require institutional care

b.

Have no social or family support

c.

Are unable to afford any medical treatment

d.

Are capable of taking charge of their own lives

ANS: d

d. The majority of older adults is interested in their health and is capable of taking charge of their lives.

a. Most older adults do not require institutional care.

b. The majority of older adults have social or family support. Most older adults live with a spouse or have other living arrangements, such as living with a family member.

c. Most older adults receive social security benefits and are able to afford medical treatment.

REF: Text Reference: p. 249

13. To assist older adults to meet their needs for sexuality, the nurse should recognize that:

a.

Therapeutic medications may alter sexual function.

b.

Physiological changes do not adversely influence sexual activity.

c.

Sexual interest declines and then fades completely with age.

d.

Prevention of sexually transmitted diseases is no longer an issue with this age group.

ANS: a

a. Many older adults use prescription medications that depress sexual activity such as antihypertensives, antidepressants, sedatives, or hypnotics. Some drugs increase libido in older adults. For example, phenothiazine increases sexual desire in women, and levodopa has a similar effect in men.

b. Physiological changes may have an adverse influence on sexual activity. The older man may experience decreased firmness in his erection, a decreased need for ejaculation with orgasm, or a longer recovery period between episodes of intercourse. The older woman may experience vaginal dryness.

c. It is a common misconception that older adults are not interested in sex. The older adults libido does not decrease, although frequency of sexual activity may decline.

d. Information about the prevention of sexually transmitted diseases should be included when appropriate.

REF: Text Reference: p. 247

14. The nurse is presenting an information session on nutritional guidelines at a senior living center. Incorporated into the discussion are the recommendations for nutritional intake for individuals of this age group, which includes a reduction in:

a.

Fiber

b.

Protein

c.

Vitamin A

d.

Refined sugars

ANS: d

d. Good nutrition for older adults includes a limited intake of refined sugars.

a. Fiber should not be reduced as it has benefits of aiding bowel elimination and lowering cholesterol.

b. Protein should not be reduced. Protein intake may be lower than recommended if older adults have reduced financial resources or limited access to grocery stores. Difficulty chewing meat also may limit protein intake.

c. Vitamin A does not need to be reduced in the older adult. Vitamin intake may be less than recommended if shopping for fresh fruits and vegetables is difficult.

REF: Text Reference: p. 250

15. The nurse is presenting an information session on nutritional guidelines at a senior living center. Incorporated into the discussion are the recommendations for nutritional intake for individuals of this age group. Which of the following foods meets the recommended nutritional guidelines for older adults?

a.

Grilled chicken

b.

Hamburger and French fries

c.

Hot dog with pickle relish

d.

Baked potato with cheese and bacon bits

ANS: a

a. Grilled chicken would be a good source of protein that is also low in fat.

b. A hamburger and French fries are high in fat content and calories, making them a less desirable food choice.

c. A hot dog with pickle relish is high in fat and sodium. Good nutrition for the older adult includes a limited intake of fat and salt.

d. A baked potato with cheese and bacon bits is higher in calories and fat. A plain baked potato would be a more healthful food choice.

REF: Text Reference: p. 250

16. In the assessment of older adult clients, it is often difficult to discriminate between delirium and dementia. A major difference that the nurse is alert to is that delirium is characterized by:

a.

Lasting months to years

b.

A normal state of alertness

c.

A slow progression

d.

Occurrences at twilight or darkness

ANS: d

d. Delirium is characterized by short, diurnal fluctuations in symptoms, worse at night, in darkness, and on awakening.

a. Delirium lasts hours to less than 1 month, seldom longer. Dementia may last months to years.

b. Delirium is characterized by fluctuating alertness; may be lethargic or hypervigilant. Alertness is generally normal with dementia.

c. Delirium has an abrupt onset. Dementia has a slow progression.

REF: Text Reference: p. 245

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