FUNDAMENTALS OF NURSING EVOLVE CHAPTER 13 OLDER ADULT
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When caring for the older adult, it is important to:
A. Repeat yourself often because older adults are forgetful
B. Treat the client as an individual with a unique history of his or her own
C. Disregard the older adult’s experiences -
b. Although many older adults may share the same physiological changes of aging, each individual should be assessed for his or her own personal strengths and limitations. To treat older adults otherwise would distort the caregiver's understanding of the individual.
a. A common stereotype of older adults is that they are forgetful, yet many centenarians have good memories.
c. An effective teaching technique is to draw on the older adult's past experiences. It also helps demonstrate respect for the older adult as a unique and valued individual.
d. A common misconception is that older adults are not interested in sex and that any interest in sexual activities is abnormal and should be discouraged. Older adults report continued enjoyment of sexual relationships. -
Older adults in the United States:
A. Are mostly living in institutional settings
B. Are proportionally decreasing in number in the population segment over age 85
C. Are increasing in number due to the extension of the average life spa -
c The number of older adults is expected to reach 70 million by 2030 due to extension of the average life span, aging of the baby boom generation, and growth of the population segment over age 85.
a Most older adults live in noninstitutional settings. In 2000, only 4.5% of all older adults resided in institutional settings.
b Both the population segment over age 85 and the percentage of older adults from minorities are increasing, not decreasing, in the United States.
d Most older people remain functionally independent despite the increasing prevalence of chronic disease. Some limitation on activities due to chronic conditions was reported in 28.8% of adults age 65 to 74 and 50.6% of adults over age 75. -
When assessing the older adult, it is important to know common physiological changes associated with aging versus abnormal findings. A normal and common physiological change may include:
A. Taking longer for the heart rate to return to baseline af -
a. The older adult''s body tries to compensate for decreased cardiac output by increasing the heart rate during exercise. However, after exercise, it takes longer for the older adult's rate to return to baseline.
b. Older adults have decreased saliva and slowing of peristalsis. Decreased small intestinal motility may increase the older adult's risk for developing constipation.
c. Urinary incontinence is an abnormal condition, not a normal physiological response to aging. Older men with an enlarged prostate gland may develop incontinence. Older women may experience stress incontinence when they cough, sneeze, or lift an object. This is a result of weakening of the perineal and bladder muscles. Urinary incontinence should have medical follow-up, especially because it places the older adult at greater risk for skin breakdown.
d. The older adult does have decreased muscle mass and strength. There is also a decrease in the number of neurons in the nervous system, which can lead to changes in the special senses. However, neither of these factors is responsible for the older adult's experiencing cold feet. Cold feet would more likely be the result of decreased cardiac output and decreased circulation in the lower extremities as evidenced by weaker peripheral pulses in the feet. -
To meet the psychosocial needs of the older adult, the nurse may:
A. Use appropriate therapeutic touch
B. Increase the use of salt and sugar to compensate for a diminished sense of taste
C. Use blue, green, and pastel shades to help cr -
a. Touch is a therapeutic tool that nurses can use to help comfort the older adult. Appropriate touch can help combat feelings of social isolation and rejection while aiding the older adult's self-concept and self-esteem.
b. Older adults may have a diminished sense of taste because they often have fewer taste buds. However, this is a physiological change, not a psychosocial need. Furthermore, salt may be limited in older adults' diet if they have problems with hypertension and this should be assessed first, as well as making sure they are not diabetic before giving sugar indiscriminately.
c. Older adults have altered color perception with increased difficulty discriminating between blue, green, and pastel shades. If color is used to create landmarks, such as the door to their room, colors such as red, orange, or yellow should be used.
d. Although large-print material and more ambient light may be helpful, older adults have increased sensitivity to the effects of glare. This intervention does not meet a psychosocial need -
An older adult recently diagnosed with a urinary tract infection displays sudden onset of confusion. She most likely is experiencing:
A. Dementia
B. Delirium
C. Depression
D. Social isolation -
b. Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as a urinary tract infection. Onset is typically sudden.
a. Dementia is characterized by a gradual, progressive, irreversible cerebral dysfunction that leads to a decline in the ability to perform activities of daily living.
c. Depression typically has an insidious onset where the person displays a lack of interest or pleasure in living. Thinking and perception remain intact except in severe cases.
d. Social isolation is characterized by reduced interaction with others. It may be by choice or in response to conditions that inhibit the ability or the opportunity to interact with others. -
To help reduce confusion of the older adult at night, the nurse may:
A. Provide bright light
B. Place hearing aids in drawer so the client does not hear all of the environmental noise
C. Make telephone calls to friends or family member -
c. When confusion varies by time of day or is related to environmental factors, the nurse can use creative, nonpharmacological measures such as making the environment more meaningful, providing adequate light, encouraging use of assistive devices (glasses, hearing aids), or making telephone calls to friends or family members to let older adults hear their voices. Key elements of reality orientation include frequent reminders of person, time, and place; the use of environmental aids such as clocks, calendars, and personal belongings; and stability of environment, routine, and staff.
a. Older adults have difficulty adjusting to abrupt changes from dark areas to light areas (and the reverse). Bright light may also cause glare, which would make seeing more difficult for the older adult. Interventions to increase ambient light should not increase glare.
b. Hearing aids should be given to older adults so they will be less likely to misunderstand what they hear. Reducing background noise may also help their hearing.
d. Nonpharmacological methods should always be used first. Some sleep aids may only increase confusion. -
Older adults are at increased risk for drug toxicity because they:
A. Have increased serum albumin levels
B. Have reduced kidney functioning
C. Have decreased adipose tissue to store lipid-soluble drugs
D. Often take their medica -
b. A decreased number of functioning nephrons and decreased glomerular filtration rate in older adults places them at greater risk for drug toxicity for drugs excreted through the renal system. The biological half-life is extended, and drugs take longer to be filtered from the body; the risk of adverse reactions is increased.
a. The older adult has reduced (not increased) serum albumin levels, making protein-bound drugs compete for protein-binding sites. If the serum albumin level is low, the client is at greater risk for toxicity despite normal or low blood levels of the drug.
c. The older adult has increased adipose tissue compared to lean body mass. Drugs stored in adipose tissue (lipid-soluble drugs) have increased tissue concentrations and accumulate and remain in the body longer.
d. This is a false statement generalizing the behavior of older adults -
To enhance the effectiveness of teaching the older adult, the nurse should:
A. Realize that older adults are less able to learn
B. Speak in clear, low-pitched tones
C. Present abstract material rather than concrete material
D. Pr -
b. An effective teaching strategy is to speak keeping your tone of voice low and at a moderate rate and volume. Older adults can hear low sounds better than high-frequency sounds.
a. This is a false stereotype of the older adult. Although the process of learning may be affected by age-related changes in vision or hearing or by reduced energy and endurance, older adults are lifelong learners.
c. The nurse should present concrete rather than abstract material to facilitate learning by older adults.
d. Ideas should be presented one at a time to enhance learning. -
When assessing the older adult, the nurse should review the client’s achievement of developmental tasks. For the older adult, these may include all of the following except:
A. Coping with the loss of the work role
B. Accepting himself or h -
d. This is not a developmental task of the older adult but rather a belief of the disengagement theory of aging. This psychosocial theory states that aging individuals withdraw from customary roles and engage in more self-focused activities.
a. Older adults retired from employment outside the home are challenged to cope with the loss of that work role, as well as a spouse who may need to adjust to role changes. Retired adults may have to find new ways to occupy their time.
b. Older adults face the necessity of adjustment to the physical changes that accompany aging. Acceptance of personal aging does not mean retirement into inactivity, but it does require a realistic review of strengths and limitations.
c. Adult children and aging parents negotiate the parameters of changed roles. -
General health promotion and illness prevention measures the nurse may recommend to older adults should include:
A. Immunization for influenza every 6 to 8 years
B. Immunization for pneumococcal pneumonia annually
C. Regular exercise < -
c. Regular exercise is a general preventative measure the nurse may recommend. Others include weight reduction if overweight, management of hypertension, smoking cessation, and immunization update.
a. Annual immunization for influenza of all older adults is strongly recommended. Approximately 95% of deaths in the United States from influenza occur among adults age 65 and older.
b. Pneumococcal pneumonia vaccine is given only once, although revaccination 6 to 8 years after the initial vaccination is recommended by some authorities. This vaccine is recommended for all adults over age 65.
d. Older adults should take medications as prescribed. -
Nurses have the responsibility to dispel myths and replace stereotypes of older adults with accurate information. The nurse knows most older adults:
A. Are confused
B. Are forgetful and rigid
C. Are unable to understand and learn new i -
d. The older adult does have an alteration in hormone production with decreased ability to respond to stress.
a. A common misconception about aging is that cognitive impairments are widespread among older adults. Confusion is not a normal aging change.
b. Some people may believe this false stereotype of the older adult, yet centenarians are described as having good memories, broad social contacts and interests, and tolerance for others.
c. Although the process of learning may be affected by age-related changes in vision or hearing or by reduced energy and endurance, older adults are lifelong learners. -
The older adult is at risk for falls for various reasons. To help prevent falls the nurse may:
A. Use vest restraints when the older adult goes to bed
B. Instruct the older adult to place throw rugs on the floor to remove glare
C. Inst -
c. Simple interventions in the home such as providing a clear pathway to the bathroom and providing a night-light in the bathroom can reduce falls related to nighttime trips to the toilet.
a. The use of restraints requires a physician's order and does not guarantee the prevention of falls.
b. Picking up throw rugs and other items on the floor reduces slipping and tripping.
d. Reducing background noise may help the client hear better, but not reduce falls. -
Which of the following is not a normal physiological change associated with aging?
A. Decreased cardiac output
B. Reduced ability to see in darkness
C. Smooth, brown, irregularly shaped spots on the backs of hands and forearms
D. -
d. Bone demineralization may occur, but osteoporosis is not a normal physiological change of aging.
a. Decreased contractile strength of the myocardium results in a decreased cardiac output.
b. Eye changes include a reduced ability to see in darkness and to adapt to abrupt changes from dark areas to light areas (and the reverse). Presbyopia, a progressive decline in the ability of the eyes to accommodate for close, detailed work, is also common.
c. Age spots, or senile lentigo, may be present, initially appearing on the backs of the hands and on forearms.