Chapter 30: Older Adults

Multiple Choice

1. When caring for an older adult, the nurse would know that wound healing rate reduces normally with aging by

A) 20%.

B) 30%.

C) 40%.

D) 50%.

Ans: D

Age Group: Older Adult Chapter: 30

Client Type: Population

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 1

Page and Header: 926, Skin, Hair, and Nails

Taxonomic Level: Knowledge

Feedback: Decreased mitotic activity of cells that accompanies aging normally leads to a 50% reduction in rate of wound healing.

2. A 77-year-old patient comes to the clinic and reports difficulty with driving at night. What would be the most appropriate response from the nurse?

A) “It is nothing to worry about.”

B) “It's just something that happens with aging.”

C) “With aging, the pupils do not respond to light as quickly.”

D) “This can be serious and needs to be evaluated by the physician immediately.”

Ans: C

Age Group: Older adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Difficult

Objective: 1, 2

Page and Header: 926, Eyes and Vision

Taxonomic Level: Application

Feedback: Slowed pupillary responses lead to a difficulty in accommodating to changes in light, difficulty with night driving, and problems with glare. This explanation is more helpful than simply characterizing the problem as “something that happens.” The patient's statement requires follow-up, but it is not an emergency.

3. What screening tool is most commonly used to identify older adults at high nutritional risk who may need interventions to improve nutritional status?

A) LAWTON

B) DETERMINE

C) FIM

D) KATZ

Ans: B

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 4, 5

Page and Header: 931, Personal History

Taxonomic Level: Knowledge

Feedback: The screening tool DETERMINE identifies older adults at high nutritional risk who may require interventions to improve nutritional status. The LAWTON measures ADL capabilities, as do the FIM and the KATZ.

4. During a home visit, the nurse is assessing the medication history of a patient who lives alone and has had a recent history of delirium. The patient states that she takes her medications as prescribed, but there has been evidence in the past of missed doses. How should the nurse best corroborate the patient's claim?

A) Speak to the pharmacist who filled the patient's prescriptions

B) Ask the patient if there is anyone who can confirm that she is taking her medications as prescribed

C) Ask the patient to describe her daily routing around taking her medications

D) Compare the number of pills on hand to the date the prescription was filled

Ans: D

Age Group: Older Adult Chapter: 30

Client Type: Individual

Competency Category: Health and Wellness

Difficulty: Difficult

Objective: 5

Page and Header: 933, Medications/Polypharmacy

Taxonomic Level: Application

Feedback: Nurses can identify accuracy by calculating how many days are between today's date and the refill date, noting how many pills the pharmacist included and counting out the number of tablets left in the container to obtain an estimate of pills taken. The pharmacist would not likely be of assistance. Many patients do not have another person who could confirm accuracy. Asking the patient to describe her routine may be useful but would constitute subjective data.

5. A student is giving an oral presentation in his geriatric nursing class about insomnia. The student is aware of the high incidence and prevalence of this problem among older adults. What is a risk factor that the student should cite?

A) Being married

B) Female gender

C) Fluid volume deficit

D) Large number of adult children

Ans: B

Age Group: Older Adult

Chapter: 30

Client Type: Population

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 3

Page and Header: 935, Focused Health History Related to Common

Symptoms/Signs

Taxonomic Level: Analysis

Feedback: Insomnia may be either acute or chronic. It may affect falling asleep, staying asleep, or early morning wakening. Risk factors include female gender, increased age, medical or psychiatric illness, and shift work. Fluid imbalance, being married, and having numerous adult children are not linked to insomnia.

6. A nurse is caring for a 72-year-old woman who may be a victim of elder abuse. When asking the patient if someone has hurt her, the nurse knows that many times elder abuse is not reported because

A) some patients are ashamed to admit being hurt by someone.

B) some patients do not remember being hurt.

C) some patients do not think that health care providers can help them.

D) some patients do not think that they are being abused.

Ans: A

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Health and Wellness

Difficulty: Moderate

Objective: 8, 9

Page and Header: 936, Abuse

Taxonomic Level: Comprehension

Feedback: Many victims of elder abuse are isolated; some are ashamed and embarrassed or feel guilt and self-blame. In addition, some elders experience fear of reprisal, retribution from caregivers, or losing their home or independence. Others are pressured by relatives not to report. Failure to report elder abuse is usually not the result of forgetfulness, skepticism of the ability of health care providers to give assistance, or comprehension about what is happening.

7. A patient has come to the clinic for a routine checkup. She is 77 years old, weighs 80 kg, stands 160 cm tall, and lives alone. Her BP is 147/89, pulse is 80, and respirations are 18. The nurse is planning her patient teaching. What is an appropriate topic to include in this patient's teaching?

A) Keeping floors clear

B) Maintaining social contacts

C) Encouraging a diet that supports a normal BMI

D) Providing information on diabetes treatment

Ans: C

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Difficult

Objective: 6, 7

Page and Header: 950, Nursing Diagnosis, Outcomes, and Interventions

Taxonomic Level: Analysis

Feedback: The patient's current BMI is high, due to her comparatively heavy weight and short stature. Thus, the most pressing concern is for the older adult to follow a diet that would support a normal BMI. Nothing in the scenario describes safety risks at home, social isolation, or current diabetes.

8. A patient has just been diagnosed with osteopenia. To help prevent progression to osteoporosis, the nurse would teach this patient about what?

A) Vitamin D supplements

B) Vitamin E supplements

C) Vitamin B12 supplements

D) Vitamin A supplements

Ans: A

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Health and Wellness

Difficulty: Easy

Objective: 2

Page and Header: 934, Risk Assessment and Health Promotion

Taxonomic Level: Application

Feedback: Vitamin D and calcium supplementation as appropriate can help prevent osteoporosis. Bone density is not directly dependent on vitamin E, A, or B12 intake.

9. The nurse is preparing to conduct an admission assessment on a 76-year-old man. In order to promote communication, what would be important to do before interviewing this patient?

A) Make sure the door is not blocked

B) Speak in a louder than normal voice and use simple phrases

C) Provide the patient with a hearing aid

D) Reduce or eliminate background noise

Ans: D

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Nurse-Client Partnership

Difficulty: Moderate

Objective: 6

Page and Header: 929, Interviewing the Older Adult

Taxonomic Level: Application

Feedback: It is essential to reduce or eliminate background noise as much as possible when carrying on conversations. This includes turning off the television or radio in the patient's room and closing the door to reduce sounds of telephones, beepers, alarms, or pagers. Before beginning the interview, it would not be necessary to make sure the door is not blocked or to speak in a louder than normal voice. The scenario does not say that the patient requires a hearing aid.

10. The nurse is admitting an 82-year-old woman to the short stay unit for same-day surgery. What information should the nurse try to have before beginning the interview process?

A) The patient's view of her own health

B) Whether the patient uses a cane

C) The patient's medical prognosis

D) The patient's educational level

Ans: D

Age Group: Adult of Advanced Age

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Difficult

Objective: 6

Page and Header: 929, Interviewing the Older Adult

Taxonomic Level: Application

Feedback: Consideration of the patient's educational level is critical, and interview questions should match the older adult's knowledge level. It would not be necessary to know the patient's view of her health status or use of assistive devices prior to the interview; these data would be revealed during the interview itself. It is not necessary to know the patient's prognosis before beginning the interview.

11. The nurse is performing a home visit to an 85-year-old man who lives alone. The nurse notes that the patient has poor hygiene and that his dress is inappropriate for the time of year. The nurse knows that these findings might be caused by what?

A) Sensory changes

B) New onset of bipolar disorder

C) Decreased functional ability

D) Cultural differences

Ans: C

Age Group: Adult of Advanced Age

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 8

Page and Header: 939, General Survey

Taxonomic Level: Analysis

Feedback: Poor hygiene and inappropriate dress may indicate decreased functional ability or may result from medications, infection, dehydration, or nutritional status. Sensory changes can affect an older adult's choice of dress but are less likely to cause poor hygiene. Bipolar disorder is unlikely to have a new onset late in life and culture is unlikely to underlie poor hygiene.

12. The nurse is caring for a new 79-year-old patient whose gait is characterized by steps that are uneven and shorter than most adults. How should the nurse explain this phenomenon?

A) The patient has a narrower base of support.

B) The patient walks bent forward.

C) The patient's age makes this a normal phenomenon.

D) The patient has loss of balance.

Ans: C

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 8

Page and Header: 939, General Survey

Taxonomic Level: Analysis

Feedback: By the eighth or ninth decade, physical appearance changes, with sharper body contours and more angular facial features. Posture tends to have a general flexion, and the patient's gait tends to have a wider base of support to compensate for diminished balance. Steps tend to be shorter and uneven. The patient may need to use the arms to help aid in balance.

13. An older adult patient comes to the dermatology clinic to have a cancerous lesion removed from the palm of his hand. The nurse knows that cancer on the palm of the hand is more common in

A) Caucasians.

B) African Canadians.

C) Asians.

D) First Nations.

Ans: B

Age Group: Older Adult Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 6

Page and Header: 947, Cultural Considerations

Taxonomic Level: Knowledge

Feedback: Skin cancers are more common on the palms, soles, and nail beds in African Canadians.

14. A nurse who provides care on the gerontology unit of a hospital is preparing to conduct a comprehensive admission assessment of a female patient. Which of the following principles should the nurse integrate into this assessment?

A) Break up the assessment into more than one session in order to avoid fatiguing the patient

B) Explain to the patient that her responses will determine how quickly she will recover

C) Conduct the assessment spontaneously throughout the day rather than at the patient's bedside

D) Ask the patient's family members to provide confirmation of the patient's responses

Ans: A

Age Group: Older adult Chapter: 30

Client Type: Individual

Competency Category: Nurse-Client Partnership

Difficulty: Difficult

Objective: 4

Page and Header: 949, Organizing and Prioritizing

Taxonomic Level: Application

Feedback: Assessment of the older adult usually proceeds from general to specific and from head to toe and may need to be conducted over several visits to avoid tiring the patient. However, the assessment should still be conducted explicitly and at the bedside or another private location. It is not normally necessary to ask family members to confirm findings, except when there is a justifiable reason to doubt the patient's response. The patient's responses will not directly influence the speed of her recovery.

15. The nurse is doing a shift assessment on a 72-year-old patient with diabetes who has a 60 pack-year history of smoking. The nurse cannot palpate a dorsalis pedis pulse even with a Doppler ultrasound. When reviewing previous assessment findings, the nurse reads that the patient's pulses were weakly palpable. What would be the first nursing action?

A) Notify the primary provider

B) Reevaluate the pulse again the next day

C) Reevaluate the pulse after mobilizing the patient

D) Determine if the patient has a history of heart disease

Ans: A

Age Group: Older adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Difficult

Objective: 8, 10

Page and Header: 945, Peripheral Vascular

Taxonomic Level: Application

Feedback: Absent peripheral pulses are of great concern and should be noted in the record. The primary provider should be contacted if this finding is new. It is more common in a person with a long history of smoking or who has diabetes; it can seriously interfere with wound healing. Assessing for a history of heart disease does not take precedence over notifying the primary provider.

16. A care aide tells the nurse that an older adult patient has a pulse of 105 beats/minute. This pulse rate should be followed up promptly because

A) older adults have poor cardiac reserves.

B) the patient is likely taking too many medications.

C) the patient needs to be reassured that providers care about him or her.

D) older adults usually have lower than normal pulse rates.

Ans: A

Age Group: Older Adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 8

Page and Header: 944, Heart and Neck Vessels

Taxonomic Level: Analysis

Feedback: Pulses greater than 100 are abnormal and should be taken seriously. Because of their poor cardiac reserves, older adults do not tolerate these pulse rates well for long periods. The scenario does not mention the patient's medications. Pulse rates on older adults often run in the 50 to 60 bpm range, but not always. While patients can benefit from reassurance, this is not the primary concern in this scenario.

17. The daughter of a palliative patient calls the clinic and asks to speak to the nurse. The daughter tells the nurse that her mother is taking morphine for advanced cancer and has become constipated. What would be the nurse's best response?

A) “People can become constipated for no reason at all.”

B) “People can become constipated when they eat a lot of fibre.”

C) “People can become constipated when taking those medications.”

D) “People can become constipated when they are under significant stress.”

Ans: C

Age Group: Older Adult

Chapter: 30

Client Type: Family

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 8

Page and Header: 952, Pulling It All Together: An Example of Reflection and Critical Thinking

Taxonomic Level: Application

Feedback: Constipation is usually related to multiple medications, inactivity, and low fluid/bulk intake. Eating a large amount of fibre does not normally cause constipation. There is generally an identifiable reason for constipation.

18. The hospital nurse is caring for an older adult who is not eating because “it doesn't taste like what I eat at home.” What would be an appropriate nursing intervention for this patient?

A) Serve five to six small meals per day rather than three larger meals

B) Arrange for the patient's family to bring in his favorite foods

C) Serve in-between-meal snacks

D) Serve more sweets and simple carbohydrates to the patient

Ans: B

Age Group: Older adult

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Moderate

Objective: 6

Page and Header: 950, Nursing Diagnosis, Outcomes, and Interventions

Taxonomic Level: Application

Feedback: Assessing food preferences and obtaining favorite foods should help promote intake. Serving more meals or in-between-meal snacks will not help if the patient does not like the food. The scenario does not say the patient likes sweets, and serving many sweets would not promote optimal nutrition.

19. A gerontological nurse has created a nursing care plan for an 81-year-old patient and documented the plan in the patient's health record. The nursing care plan should be based primarily on

A) objective data.

B) subjective data.

C) assessment data.

D) a preprinted care plan.

Ans: C

Age Group: Adult of Advanced Age

Chapter: 30

Client Type: Individual

Competency Category: Changes in Health

Difficulty: Easy

Objective: 10

Page and Header: 952, Pulling It All Together: An Example of Reflection and Critical Thinking

Taxonomic Level: Application

Feedback: The nurse uses assessment data to formulate a nursing care plan with patient outcomes and interventions. The nurse uses both objective and subjective data, but neither is used in isolation. The nurse may use a preprinted care plan, but this must reflect individualized assessment data.