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Chapter 11: Health Care of the Older Adult You are providing care for an 82-year-old man whose signs and symptoms of Parkinson disease havebecome more severe over the past several months. The man tells you that he can no longer do as many things for himself as he used to be able to do. What factor s...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter11:HealthCareoftheOlderAdult  1.

Youareprovidingcareforan82-year-oldmanwhosesignsandsymptomsofParkinsondiseasehave becomemoresevereoverthepastseveralmonths.Themantellsyouthathecannolongerdoasmany thingsforhimselfasheusedtobeabletodo.Whatfactorshouldyourecognizeasimpactingyour patientslifemostsignificantly?

A)

Neurologicdeficits

B)

Lossofindependence

C)

Age-relatedchanges

D)

Tremorsanddecreasedmobility

Ans:

B Feedback: Thispatientsstatementplacesapriorityonhislossofindependence.Thisisundoubtedlyaresultofthe neurologicchangesassociatedwithhisdisease,butthisisnotthefocusofhisstatement.Thisisa diseaseprocess,notanage-relatedphysiologicalchange.

2.

Agerontologicnursepractitionerprovidesprimarycareforalargenumberofolderadultswhoare livingwithvariousformsofcardiovasculardisease.Thisnurseiswellawarethatheartdiseaseisthe leadingcauseofdeathintheaged.Whatisanage-relatedphysiologicalchangethatcontributestothis trend?

A)

Heartmuscleandarterieslosetheirelasticity.

B)

Systolicbloodpressuredecreases.

C)

Restingheartratedecreaseswithage.

D)

Atrial-septaldefectsdevelopwithage.

Ans:

A Feedback: Theleadingcauseofdeathforpatientsovertheageof65yearsiscardiovasculardisease.Withage, heartmuscleandarterieslosetheirelasticity,resultinginareducedstrokevolume.Asapersonages, systolicbloodpressuredoesnotdecrease,restingheartratedoesnotdecrease,andtheagedarenotless likelytoadoptahealthylifestyle.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

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Anoccupationalhealthnurseoverhearsanemployeetalkingtohismanagerabouta65-year-old coworker.Whatphenomenonwouldthenurseidentifywhenhearingtheemployeestate,Heshouldjust retireandmakewayforsomenewblood.?

A)

Intolerance

B)

Ageism

C)

Dependence

D)

Nonspecificprejudice

Ans:

B Feedback: Ageismreferstoprejudiceagainsttheaged.Intoleranceisimpliedbytheemployeesstatement,butthe intoleranceisaimedatthecoworkersage.Theemployeesstatementdoesnotraiseconcernabout dependence.Theprejudiceexhibitedinthestatementisveryspecific.

4.

Thenurseiscaringfora65-year-oldpatientwhohaspreviouslybeendiagnosedwithhypertension. Whichofthefollowingbloodpressurereadingsrepresentsthethresholdbetweenhigh-normalblood pressureandhypertension?

A)

140/90mmHg

B)

145/95mmHg

C)

150/100mmHg

D)

160/100mmHg

Ans:

A Feedback: Hypertensionisthediagnosisgivenwhenthebloodpressureisgreaterthan140/90mmHg.Thismakes theotheroptionsincorrect.

5.

A)

Youarethenursecaringforan85-year-oldpatientwhohasbeenhospitalizedforafracturedradius.The patientsdaughterhasaccompaniedthepatienttothehospitalandasksyouwhatherfathercandoforhis verydryskin,whichhasbecomesusceptibletocrackingandshearing.Whatwouldbeyourbest response? Heshouldlikelytakeshowersratherthanbaths,ifpossible.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Makesurethatheappliessunscreeneachmorning.

C)

Dryskinisanage-relatedchangethatislargelyinevitable.

D)

Trytohelpyourfatherincreasehisintakeofdairyproducts.

Ans:

A

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Feedback: Showersarelessdryingthanhottubbaths.Sunexposureshouldindeedbelimited,butdailyapplication ofsunscreenisnotnecessaryformanypatients.Dryskinisanage-relatedchange,butthisdoesnot meanthatnoappropriateinterventionsexisttoaddressit.Dairyintakeisunrelated. 6.

Anelderlypatienthascomeintotheclinicforhertwice-yearlyphysical.Thepatienttellsthenursethat sheisgenerallyenjoyinggoodhealth,butthatshehasbeenhavingoccasionalepisodesofconstipation overthepast6months.Whatinterventionshouldthenursefirstsuggest?

A)

Reducetheamountofstressshecurrentlyexperiences.

B)

Increasecarbohydrateintakeandreduceproteinintake.

C)

Takeherballaxatives,suchassenna,eachnightatbedtime.

D)

Increasedailyintakeofwater.

Ans:

D Feedback: Constipationisacommonprobleminolderadultsandincreasingfluidintakeisanappropriateearly intervention.Thisshouldlikelybeattemptedpriortorecommendingsennaorotherlaxatives.Stress reductionisunlikelytowhollyresolvetheproblemandthereisnoneedtoincreasecarbohydrateintake andreduceproteinintake.

7.

An84-year-oldpatienthasreturnedfromthepost-anestheticcareunit(PACU)followinghip arthroplasty.Thepatientisorientedtonameonly.Thepatientsfamilyisveryupsetbecause,before havingsurgery,thepatienthadnocognitivedeficits.Thepatientissubsequentlydiagnosedwith postoperativedelirium.Whatshouldthenurseexplaintothepatientsfamily?

A)

Thisproblemisself-limitingandthereisnothingtoworryabout.

B)

Deliriuminvolvesaprogressivedeclineinmemorylossandoverallcognitivefunction.

C)

Deliriumofthistypeistreatableandhercognitionwillreturntopreviouslevels.

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D)

Thisproblemcanberesolvedbyadministeringantidotestotheanestheticthatwasusedinsurgery.

Ans:

C Feedback: Surgeryisacommoncauseofdeliriuminolderadults.Deliriumdiffersfromothertypesofdementiain thatdeliriumbeginswithconfusionandprogressestodisorientation.Ithassymptomsthatarereversible withtreatment,and,withtreatment,isshortterminnature.Itispatronizingandinaccuratetoreassure thefamilythatthereisnothingtoworryabout.Theproblemisnottreatedbytheadministrationof antidotestoanesthetic.

8.

ThenurseisprovidingpatientteachingtoapatientwithearlystageAlzheimersdisease(AD)andher family.Thepatienthasbeenprescribeddonepezilhydrochloride(Aricept).Whatshouldthenurse explaintothepatientandfamilyaboutthisdrug?

A)

ItslowstheprogressionofAD.

B)

ItcuresADinasmallminorityofpatients.

C)

ItremovesthepatientsinsightthatheorshehasAD.

D)

ItlimitsthephysicaleffectsofADandotherdementias.

Ans:

A Feedback: ThereisnocureforAD,butseveralmedicationshavebeenintroducedtoslowtheprogressionofthe disease,includingdonepezilhydrochloride(Aricept).Thesemedicationsdonotremovethepatients insightoraddressphysicalsymptomsofAD.

9.

Anurseiscaringforan86-year-oldfemalepatientwhohasbecomeincreasinglyfrailandunsteadyon herfeet.Duringtheassessment,thepatientindicatesthatshehasfallenthreetimesinthemonth,though shehasnotyetsufferedaninjury.Thenurseshouldtakeactionintheknowledgethatthispatientisata highriskforwhathealthproblem?

A)

Ahipfracture

B)

Afemoralfracture

C)

Pelvicdysplasia

D)

Tearingofameniscusorbursa

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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A Feedback: Themostcommonfractureresultingfromafallisafracturedhipresultingfromosteoporosisandthe conditionorsituationthatproducedthefall.Theotherlistedinjuriesarepossible,butlesslikelythana hipfracture.

10. Thecasemanagerisworkingwithan84-year-oldpatientnewlyadmittedtoarehabilitationfacility. Whendevelopingacareplanforthisolderadult,whichfactorsshouldthenurseidentifyaspositive attributesthatbenefitcopinginthisagegroup?Selectallthatapply. A)

Decreasedrisktaking

B)

Effectiveadaptationskills

C)

Avoidingparticipationinuntestedroles

D)

Increasedlifeexperience

E)

Resiliencyduringchange

Ans:

B,D,E Feedback: Becausechangesinlifepatternsareinevitableoveralifetime,olderpeopleneedresiliencyandcoping skillswhenconfrontingstressesandchange.Itisbeneficialifolderadultscontinuetoparticipateinrisk takingandparticipationinnew,untestedroles.

11. Anursewillconductaninfluenzavaccinationcampaignatanextendedcarefacility.Thenursewillbe administeringintramuscular(IM)dosesofthevaccine.Ofwhatage-relatedchangeshouldthenursebe awarewhenplanningtheappropriateadministrationofthisdrug? A)

Anolderpatienthaslesssubcutaneoustissueandlessmusclemassthanayoungerpatient.

B)

Anolderpatienthasmoresubcutaneoustissueandlessdurableskinthanayoungerpatient.

C)

Anolderpatienthasmoresuperficialandtortuousnervedistributionthanayoungerpatient.

D)

AnolderpatienthasahigherriskofbleedingafteranIMinjectionthanayoungerpatient.

Ans:

A Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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WhenadministeringIMinjections,thenurseshouldrememberthatinanolderpatient,subcutaneousfat diminishes,particularlyintheextremities.Musclemassalsodecreases.Therearenosignificant differencesinnervedistributionorbleedingrisk. 12. Anelderlypatient,whilebeingseeninanurgentcarefacilityforapossiblerespiratoryinfection,asks thenurseifMedicareisgoingtocoverthecostofthevisit.Whatinformationcanthenursegivethe patienttohelpallayherconcerns? A)

Medicarehasacopaymentformanyoftheservicesitcovers.Thisrequiresthepatienttopayapart ofthebill.

B)

Medicarepaysfor100%ofthecostforacute-careservices,sothecostofthevisitwillbecovered.

C)

Medicarewillonlypaythecostforacute-careservicesifthepatienthasaverylowincome.

D)

Medicarewillnotpayforthecostofacute-careservicessothepatientwillbebilledforthe servicesprovided.

Ans:

A Feedback: ThetwomajorprogramsthatfinancehealthintheUnitedStatesareMedicareandMedicaid,bothof whichareoverseenbytheCentersforMedicaidandMedicareServices(CMS).Bothprogramscover acute-careneedssuchasinpatienthospitalization,physiciancare,outpatientcare,homehealthservices, andskillednursingcareinanursing.Medicareisaplanspecificallyfortheelderlypopulation,and Medicaidisaprogramthatprovidesservicesbasedonincome.

13. Theadmissionsdepartmentatalocalhospitalisregisteringanelderlymanforanoutpatientdiagnostic test.Theadmissionsnurseasksthemanifhehasanadvanceddirective.Themanrespondsthathedoes notwanttocompleteanadvancedirectivebecausehedoesnotwantanyonecontrollinghisfinances. Whatwouldbeappropriateinformationforthenursetosharewiththispatient? A)

Advancedirectivesarenotlegaldocuments,soyouhavenothingtoworryabout.

B)

Advancedirectivesarelimitedonlytohealthcareinstructionsanddirectives.

C)

Yourfinancescannotbemanagedwithoutanadvancedirective.

D)

Advancedirectivesareimplementedwhenyoubecomeincapacitated,andthenyouwillusea livingwilltoallowthestatetomanageyourmoney.

Ans:

B Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Anadvancedirectiveisaformal,legallyendorseddocumentthatprovidesinstructionsforcare(living will)ornamesaproxydecisionmaker(durablepowerofattorneyforhealthcare)andcoversonlyissues relatedspecificallytohealthcare,notfinancialissues.Theydonotaddressfinancialissues.Advance directivesareimplementedwhenapatientbecomesincapacitated,butfinancialissuesareaddressed withadurablepowerofattorneyforfinances,orfinancialpowerofattorney. 14. Anurseisplanningdischargeteachingforan80-year-oldpatientwithmildshort-termmemoryloss.The dischargeteachingwillincludehowtoperformbasicwoundcareforthevenousulceronhislowerleg. Whenplanningthenecessaryhealtheducationforthispatient,whatshouldthenurseplantodo? A)

Setlong-termgoalswiththepatient.

B)

ProvidealistofusefulWebsitestosupplementlearning.

C)

Keepvisualcuestoaminimumtoenhancethepatientsfocus.

D)

Keepteachingperiodsshort.

Ans:

D Feedback: Toassisttheelderlypatientwithshort-termmemoryloss,thenurseshouldkeepteachingperiodsshort, provideglare-freelighting,linknewinformationwithfamiliarinformation,usevisualandauditorycues, andsetshort-termgoalswiththepatient.Thepatientmayormaynotbeopentotheuseofonline resources.

15. Youarethenurseplanninganeducationaleventforthenursesonasubacutemedicalunitonthetopicof normal,age-relatedphysiologicalchanges.Whatphenomenonwouldyouincludeinyourteachingplan? A)

Adecreaseincognition,judgment,andmemory

B)

Adecreaseinmusclemassandbonedensity

C)

Thedisappearanceofsexualdesireforbothmenandwomen

D)

Anincreaseinsebaceousandsweatglandfunctioninbothmenandwomen

Ans:

B Feedback: Normalsignsofagingincludeadecreaseinthesenseofsmell,adecreaseinmusclemass,adeclinebut notdisappearanceofsexualdesire,anddecreasedsebaceousandsweatglandsforbothmenandwomen. Cognitivechangesareusuallyattributabletopathologicprocesses,nothealthyaging.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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16. Ahomehealthnursemakesahomevisittoa90-year-oldpatientwhohascardiovasculardisease.During thevisitthenurseobservesthatthepatienthasbegunexhibitingsubtleandunprecedentedsignsof confusionandagitation.Whatshouldthehomehealthnursedo? A)

Increasethefrequencyofthepatientshomecare.

B)

Haveafamilymembercheckinonthepatientintheevening.

C)

Arrangeforthepatienttoseehisprimarycarephysician.

D)

Referthepatienttoanadultdayprogram.

Ans:

C Feedback: Inmorethanhalfofthecases,suddenconfusionandhallucinationsareevidentinmulti-infarctdementia Thisconditionisalsoassociatedwithcardiovasculardisease.Havingthepatientshomecareincreased doesnotaddresstheproblem,neitherdoeshavingafamilymembercheckonthepatientintheevening. Referringthepatienttoanadultdayprogrammaybebeneficialtothepatient,butitdoesnotaddressthe acuteproblemthepatientishaving,thenurseshouldarrangeforthepatienttoseehisprimarycare physician.

17. Thehomehealthnurseismakinganinitialhomevisittoa76-year-oldwidower.Thepatienttakes multiplemedicationsforthetreatmentofvariedchronichealthproblems.Thepatientstatesthathehas alsobeguntakingsomeherbalremedies.Whatshouldthenursebesuretoincludeinthepatients teaching? A)

Herbalremediesareconsistentwithholistichealthcare.

B)

Herbalremediesareoftencheaperthanprescribedmedication.

C)

Itissafesttoavoidtheuseofherbalremedies.

D)

Thereisaneedtoinformhisphysicianandpharmacistabouttheherbalremedies.

Ans:

D Feedback: Herbalremediescombinedwithprescribedmedicationscanleadtointeractionsthatmaybetoxic. Patientsshouldnotifythephysicianandpharmacistofanyherbalremediestheyareusing.Eventhough herbalremediesareconsideredholistic,thisisnotsomethingthatisnecessarytoincludeinthepatients teaching.Herbalremediesmaybecheaperthanprescribedmedicine,butthisisstillnotsomethingthat isnecessarytoincludeinthepatientsteaching.Formostpeople,itisnotnecessarytowhollyavoid herbalremedies.

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18. Youarethenursecaringforanelderlypatientwhoisbeingtreatedforcommunity-acquiredpneumonia. Sincethetimeofadmission,thepatienthasbeendisorientedandagitatedtovaryingdegrees. Appropriatereferralsweremadeandthepatientwassubsequentlydiagnosedwithdementia.What nursingdiagnosisshouldthenurseprioritizewhenplanningthispatientscare? A)

Socialisolationrelatedtodementia

B)

Hopelessnessrelatedtodementia

C)

Riskforinfectionrelatedtodementia

D)

Acuteconfusionrelatedtodementia

Ans:

D Feedback: Acuteconfusionisapriorityprobleminpatientswithdementia,anditisanimmediatethreattotheir healthandsafety.Hopelessnessandsocialisolationareplausibleproblems,butthepatientscognitionis apriority.Thepatientsriskforinfectionisnotdirectlyinfluencedbydementia.

19. Youarecaringforapatientwithlate-stageAlzheimersdisease.Thepatientswifetellsyouthatthe patienthasnowbecomecompletelydependentandthatshefeelsguiltyifshetakesanytimeforherself. Whatoutcomeswouldbeappropriateforthenursetodeveloptoassistthepatientswife? A)

Thecaregiverlearnstoexplaintothepatientwhysheneedstimeforherself.

B)

Thecaregiverdistinguishesessentialobligationsfromthosethatcanbecontrolledorlimited.

C)

Thecaregiverleavesthepatientathomealoneforshortperiodsoftimetoencourage independence.

D)

Thecaregiverprioritizesherownhealthoverthatofthepatient.

Ans:

B Feedback: Forprolongedperiods,itisnotuncommonforcaregiverstoneglecttheirownemotionalandhealth needs.Thecaregivermustlearntodistinguishobligationsthatshemustfulfillandlimitthosethatare notcompletelynecessary.Thecaregivercantellthepatientwhensheleaves,butsheshouldnotexpect thatthepatientwillrem...