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The Aging Adult

Terms in this set (35)

ageism
attitudes that stereotype the older adult on the basis of chronologic age
Alzheimer's disease
type of dementia in which discrete patches of brain tissue degenerate; this devastating disease eventually effects all body functions
cascade iatrogenesis
downward spiral or sequence of adverse events often triggered by a medical or surgical intervention during the hospitalization of an older adult
delirium
a temporary state of confusion
dementia
organic impairment of intellectual functioning, gradually leading to interference with social or occupational functioning, memory, and often personality integration
functional health
level of health defined by one's ability to carry out usual and desired daily activities
gerontologic nursing
nursing specialty concerned with the care of the older adult
gerontology
study of all aspects of the aging process and their consequences
life review/reminescence
universal phenomenon identified by Butler as a review of one's life through one's recollections
middle adult
the adult between the ages of 40 and 60 years
older adult
refers to adults over age of 65
polypharmacy
the use of many medications at the same time
reality orientation
method of care used to promote awareness of reality in confused or disoriented patients
social isolation
sense of aloneness because of decreasing relationships with others, resulting from attitudinal, geographic, financial, or illness-related factors
sundowning syndrome
describes a phenomenon when a person habitually becomes confused or disoriented with darkness
b) Delirium
Explanation: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.
An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition?

a) Disorientation
b) Delirium
c) Depression
d) Dementia
c) Dementia
Explanation: Dementia describes various disorders that progressively affect cognitive function. Delirium is a temporary state of confusion that can last from hours to weeks and resolves with treatment. Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in a few members of their group. Reminiscence is the phenomenon of an older adult telling stories of the past.
What term is used to describe various disorders that progressively affect cognitive function?

a) Ageism
b) Delirium
c) Dementia
d) Reminiscence
a) Encourage a routine for sleeping and waking.
Explanation: If sleep and rest is an area of concern for an older adult, the nurse should discourage excessive napping and encourage a routine for sleeping and waking. The nurse should assess normal bedtime patterns, time for rising, bedtime rituals, effects of pain, medications, anxiety, and depression. The routine use of sleeping pills and varied bedtime rituals should not be encouraged.
An older adult informs the nurse that she is having a difficult time sleeping at night. What action may assist the client in getting a better night of sleep?

a) Encourage a routine for sleeping and waking.
b) Encourage a routine in the use of sleeping pills.
c) Encourage the client to nap frequently during the day.
d) Encourage varied bedtime rituals nightly.
a) "the flu vaccine is administered one time each year."
Explanation: A patient should receive one dose of the flu vaccine every year.
An older adult inquires about receiving the flu vaccine. When he asks the nurse how often he should receive the flu vaccine, her best response is:

a) "the flu vaccine is administered one time each year."
b) "the flu vaccine is administered every 2 years."
c) "the flu vaccine is administered every 6 months."
d) "the flu vaccine is administered once every 5 years."
d) Smoking
Explanation: Alcohol, salt, and cholesterol all have the potential to cause harm when used in excess. However, moderate and conscientious intake of each is not unhealthy, and complete elimination of cholesterol or salt from the diet would in fact be harmful. Smoking, however, is never a benign activity and even "moderate" smoking should be discontinued.
A public health nurse is participating in a health fair that is being held at a local community center. The nurse should encourage adult participants to completely eliminate which of the following from their diet and lifestyle?

a) Alcohol
b) Cholesterol
c) Salt
d) Smoking
d) Older white men
Explanation: Currently, older white men have the highest rate of suicide in the United States.
Which group of individuals has the highest rate of suicide in the United States?

a) Older Hispanic males
b) Older white females
c) Older African American males
d) Older white men
a) Every 3 years to age 40 and annually from age 40
Explanation: Physical examinations are recommended every 3 years to age 40 and every year from age 40.
A home care nurse is reviewing guidelines for health-related screenings with a 35-year-old patient. What are common screening recommendations for physical examinations?

a) Every 3 years to age 40 and annually from age 40
b) Annual physical examinations from age 30
c) Every 2 years to age 50 and annually from age 50
d) Annual physical examinations from birth
c) Ensure that the client's care is coordinated and encourage the primary care provider to review her medication regimen.
Explanation: Polypharmacy can sometimes be addressed by conducting a thorough and coordinated review of a client's medication regimen. It would be inappropriate and unsafe for the nurse to arbitrarily withhold some medications or to encourage the client to do so. The client's local pharmacist is not normally able to make independent changes to the client's medication regimen.
A home health care nurse has observed that a client 80 years of age, who has multiple chronic health problems, takes a total of 19 medications on either a scheduled or PRN (as needed) basis. How should the nurse address this client's risk of harm from polypharmacy?

a) Contact the client's local pharmacy to discuss possible changes to her medication regimen.
b) Encourage the client to reduce her medication load by withholding some medications when she is asymptomatic.
c) Ensure that the client's care is coordinated and encourage the primary care provider to review her medication regimen.
d) Recommend holistic and herbal remedies to replace some of the medications.
d) Home modification
Explanation: Older adults typically express a desire to maintain their existing living relationships and this should be facilitated as long as it is safe. Consequently, the nurse should prioritize Mrs. Jimenez's wishes. Home modification may allow her to maximize her independence and maintain her current living situation in spite of some mobility challenges.
Mrs. Jimenez, age 79, became a widow earlier this year and now resides alone in the house that she and her husband shared for 30 years. Her children have encouraged her to move, but she expresses a desire to remain in her home, despite some slight mobility challenges. The nurse who provides occasional home healthcare for Mrs. Jimenez should first propose which of the following?

a) Homesharing
b) Assisted living
c) A nursing home
d) Home modification
c) Remind him of where he is and assess why he is having difficulty sleeping.
Explanation: Reminding the client where he is will help orient him to his surroundings. Assessment is needed to determine any need that may be disturbing the client, such as the need to use the bathroom, feeling cold/warm, etc. The other responses do not include orienting the disoriented/confused client.
An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be?

a) Remind him that he must not get up unassisted and should stay in his room at night.
b) Allow him to sleep in the recliner in the day-room, so he will not disturb other clients.
c) Remind him of where he is and assess why he is having difficulty sleeping.
d) Use a matter-of-fact attitude as you gently help him back to his room.
a) whether they are ill or healthy.
Explanation: There is growing evidence that aging is not synonymous with loss of function or disability. Although coping with chronic illness is common for the older adult, the ability to adapt determines whether they are ill or healthy.
Eighty percent of older adults have one chronic illness, and most have at least two. The older adult's ability to adapt determines:

a) whether they are ill or healthy.
b) degree of loss of the physiologic reserve of the various organ systems
c) that not wanting to change makes them more determined.
d) how quickly they become overwhelmed with the "stress of it all."
b) reminiscence is a normal process in achieving ego integrity.
Explanation: Reminiscence is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Nurses can use reminiscence as a therapy to facilitate adaptation to present circumstances, and withdrawing from usual roles is termed disengagement.
A patient often actively engages in reminiscence when the nurse is delivering care. The nurse recognizes that:

a) reminiscence should be discouraged until the patient is discharged.
b) reminiscence is a normal process in achieving ego integrity.
c) reminiscence interferes with the patient's ability to accept death.
d) reminiscence occurs when a patient withdraws from usual roles.
b) Suicidal thoughts
Explanation: Although poor cognitive performance, sleep problems, and lack of initiative are manifestations of depression, the nurse should be alert for indications of suicidal thoughts or behaviors. Suicide is the most serious consequence of depression.
An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for which of the following?

a) Poor cognitive performance
b) Suicidal thoughts
c) Sleep problems
d) Lack of initiative
a) Heart muscle and arteries lose their elasticity.
Explanation: The leading cause of death for patients over the age of 65 years is cardiovascular disease. Malignant neoplasms are the second leading cause. 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.
A gerontologic nurse practitioner has a large patient population with heart disease problems. This nurse practitioner is aware that heart disease is the leading cause of death in the aged. What is the cause of this trend?

a) Heart muscle and arteries lose their elasticity.
b) Resting heart rate decreases with age.
c) The aged are less likely to adopt a healthy lifestyle.
d) Systolic blood pressure decreases.
d) Increased loss of calcium from the bones
Explanation: Some physical changes common during the middle adult years include increased fatigue, decreased cardiac output, increased loss of calcium from the bones, and decreased oil levels (resulting in dry skin).
When assessing a client during the middle adult years, the nurse recognizes which of the following as a normal physical change?

a) Increased oil levels in the skin
b) Increased cardiac output
c) Increased levels of energy
d) Increased loss of calcium from the bones
a) His career goals and retirement plans are compromised.
Explanation: The loss of his employment is a major change that disrupts his life-long goals. The middle adult is becoming aware of physical changes and limited time to live. This situation is not a hormonal crisis, and although the patient may feel the job loss is his fault, that is not what he expressed.
The nurse is assigned to a 52-year-old male patient. He is talkative and usually friendly when the nurse enters his room. Today, however, he is standing at the mirror and says: "I lost my job because the company downsized, there isn't anything I can do." As his caregiver, the nurse recognizes this expression of concern is related to which of the following?

a) His career goals and retirement plans are compromised.
b) He assumes the termination is his fault.
c) Dissatisfaction with changes in his appearance and energy levels.
d) He is in an androgenic crisis.
a) Risk of infection
Explanation: Humoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause pneumonia and infection.
Changes in T-cell function in the elderly will result in

a) Risk of infection
b) Onset of chronic disease
c) Inadequate nutrition
d) Active immunity
d) Alzheimer's disease
Explanation: Alzheimer's disease is the most common cause of dementia in older adults. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and is not itself a cause of dementia. Depression is common in older adults but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the client seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although it is a problem among older adults, it is not as common as Alzheimer's disease.
The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client?


a) Depression
b) Excessive drug use
c) Delirium
d) Alzheimer's disease
a) Beta-blockers
Explanation: Older persons experience impairment of sleep. Beta-blockers contribute to sleep disturbances.
Which of the following factors contributes to sleep disturbances in older persons?

a) Beta-blockers
b) Decreased caffeine
c) Regular bedtime
d) Exercise
a) Put side rails up before leaving the client.
Explanation: The issue is safety of a confused client, so the side rails must be up. It is not the family's responsibility to maintain his safety, a blanket is not for safety, and restraints are not routinely used.
While providing hygiene care to a confused older adult client diagnosed with Alzheimer's disease, you are called to the nursing station. To ensure patient safety you must do what?

a) Put side rails up before leaving the client.
b) Ask a family member to stay with him.
c) Reattach the restraints.
d) Cover him with a blanket for warmth.
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