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| Origin: Chapter 5- Common Aging Changes, 1
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 52, Physical Appearance |
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| 1. | During an assessment of an 82-year-old woman, a gerontological nurse learns that the woman has lost over 4 inches in height over the last several years. Which of the following factors have likely contributed to this phenomenon? Select all that apply. |
| A) | The woman’s overall proportion of body water has decreased. |
| B) | The client has experienced a loss of cartilage. |
| C) | The woman’s thyroid hormone levels have declined since the sixth decade. |
| D) | The client’s vertebrae have thinned. |
| E) | Loss of stature is a consequence of the woman’s diet. |
| F) | The woman’s long bones have decreased in length. |
| Ans: | A, B, D |
| Feedback: | |
| Reduced hydration, loss of cartilage, and thinning of vertebrae can all contribute to loss of stature. Decreased levels of TH, shortening of long bones, and diet are not noted to contribute to this phenomenon. |
| Origin: Chapter 5- Common Aging Changes, 2
Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 52, Respiratory System |
|
| 2. | A 78-year-old man has received a recent diagnosis of community-acquired pneumonia. Potential pathological findings on a recent chest x-ray have prompted his physician to order a bronchoscopy and lung function tests. Which of the following findings would be most likely suggestive of pathological processes rather than normal, age-related respiratory changes? |
| A) | The client has fewer cilia than would be found in a younger client. |
| B) | Lung function tests reveal that both maximum breathing and vital capacity are diminished since his last test. |
| C) | There is an accumulation of serous fluid between the lungs and the pleural membrane. |
| D) | The lungs are smaller than younger adults’ and there are fewer alveoli. |
| Ans: | C |
| Feedback: | |
| While decreases in the number of cilia, alveoli, lung size, and lung capacities are commonly associated with aging, an accumulation of serous fluid would not be considered a normal consequence of the aging process. |
| Origin: Chapter 5- Common Aging Changes, 3
Chapter: 5 Client Needs: D4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 1 Page and Header: 54, Cardiovascular System |
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| 3. | An 80-year-old resident of an assisted living facility is proud of the fact that he was an elite athlete during his younger years. Despite his concerted efforts to remain physically active and maintain his stamina, he is lamenting his loss of exercise tolerance in recent years. How can his nurse best respond to these concerns? |
| A) | “It’s inevitable that your heart increases in size as you age, and this is associated with a loss of cardiac efficiency.” |
| B) | “It’s normal for your heart to contract less strongly as you age, and this makes you somewhat less able to exercise vigorously.” |
| C) | “As you age, it’s common for your heart rate becomes less regular and this often results in fatigue.” |
| D) | “The normal increase in blood pressure that accompanies aging leaves you with less cardiac reserve capacity than when you were young.” |
| Ans: | B |
| Feedback: | |
| Cardiac contractility decreases as a part of normal aging. An increase in heart size, irregular heart rate, and increased blood pressure would be considered pathological conditions regardless of age. |
| Origin: Chapter 5- Common Aging Changes, 4
Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 57, Urinary System |
|
| 4. | Which of the following diagnostic and assessment findings from among the patients on a geriatric medical unit most warrants further investigation? |
| A) | An 81-year-old woman’s glomerular filtration rate (GFR) is low. |
| B) | A 78-year-old male’s stomach pH is increased. |
| C) | A 71-year-old male client’s echocardiogram reveals slight left ventricular hypertrophy. |
| D) | A 78-year-old man has recently developed urinary incontinence. |
| Ans: | D |
| Feedback: | |
| While a decrease in GFR, increase in stomach pH, and slight left ventricular hypertrophy are considered normal accompaniments to aging, urinary incontinence should be considered a pathological finding that necessitates further assessment. |
| Origin: Chapter 5- Common Aging Changes, 5
Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 57, Reproductive System |
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| 5. | A 66-year-old man has undergone a digital-rectal exam (DRE) during a visit to his family physician. The exam reveals that the client’s prostate has become enlarged since his last DRE. The most accurate conclusion that his care provider will draw from these findings is that they suggest: |
| A) | Prostate cancer |
| B) | A risk of malignancy that should be followed up |
| C) | A normal age-related change unlikely to have consequences |
| D) | A urinary tract infection |
| Ans: | B |
| Feedback: | |
| Prostatic enlargement is exceedingly common among older men, but represents a risk of malignancy that necessitates further assessment and follow-up. It is not a definitive sign of prostate cancer and is not indicative of a urinary tract infection. |
| Origin: Chapter 5- Common Aging Changes, 6
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 58, Musculoskeletal System |
|
| 6. | A 74-year-old woman has presented to the emergency department with a suspected hip fracture following a fall on the sidewalk outside her home. The nurse’s assessment of the client would recognize which of the following factors as most likely contributed to the suspected injury? |
| A) | Bone remodeling in long bones ceases in the seventh or eighth decade. |
| B) | Bone minerals and mass are reduced as part of the aging process. |
| C) | Bone marrow production of cellular components declines with age. |
| D) | Thinning disks and shortened vertebrae are common assessment findings in older adults. |
| Ans: | B |
| Feedback: | |
| A decrease in bone minerals and mass is common later in life. Bone remodeling does not, however, cease. Neither thinning disks, shortened vertebrae, nor marrow production of blood cellular components is likely to directly contribute to the client’s suspected fracture. |
| Origin: Chapter 5- Common Aging Changes, 7
Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 62, Endocrine System |
|
| 7. | A hospital client, aged 82 years, is presently undergoing an endocrine diagnostic workup in an effort to diagnose his increasing fatigue of unknown etiology. Which of the following findings would his care team recognize as potentially pathological? |
| A) | Apparent decreased thyroid gland activity. |
| B) | Decreased somatotropic growth hormone (GH) levels. |
| C) | Delayed and insufficient release of insulin by the β-cells. |
| D) | Decreased erythropoietin production by the kidneys. |
| Ans: | D |
| Feedback: | |
| While decreases in thyroid gland activity, GH, and insulin are often associated with aging, a decrease in erythropoietin production would be considered problematic and pathological. |
| Origin: Chapter 5- Common Aging Changes, 8
Chapter: 5 Client Needs: D4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/learning Objective: 2 Page and Header: 64, Memory |
|
| 8. | A care aide at a long-term care facility has assured the family of a resident that their father’s increasing forgetfulness is a normal part of the aging process. How can the nurse best respond to the care aide’s statement to the family? |
| A) | “It’s actually a myth that older people experience changes to their memory.” |
| B) | “Memory losses are a normal age-related change many people experience.” |
| C) | “Older adults have less working memory and slower retrieval, but this still requires further assessment.” |
| D) | “There is no reason for healthy older adults to experience changes in their memory unless they are experiencing dementia.” |
| Ans: | C |
| Feedback: | |
| Older adults often experience delays in retrieval of memories and working memory. Some changes in memory, even in the absence of delirium or dementia, are to be expected but they should not be discounted and would require further assessment. |
| Origin: Chapter 5- Common Aging Changes, 9
Chapter: 5 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 3 Page and Header: 65, Learning |
|
| 9. | A nurse practitioner is teaching a 90-year-old client about her new medication regimen. Which of the following principles should the nurse integrate into the teaching session? |
| A) | While numerous factors can interfere with learning, learning ability itself is not seriously altered with age. |
| B) | Older adults require simplified learning objectives and slower introduction of new directions. |
| C) | Simple association is well executed by older adults but complex analysis is normally absent. |
| D) | Successful learning late in life requires a multisensory teaching approach. |
| Ans: | A |
| Feedback: | |
| Learning ability is not seriously changed with age. It is not likely necessary to simplify learning objectives, and analysis abilities may slightly diminish but are not normally absent. A multisensory teaching approach is not noted to be required. |
| Origin: Chapter 5- Common Aging Changes, 10
Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 62, Hearing |
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| 10. | Which of the following phenomena most likely accounts for the progressive loss of hearing that an 83-year-old man is experiencing? |
| A) | Multiple changes in the structures of the inner ear. |
| B) | The effect of cognitive changes on the interpretation of auditory stimuli. |
| C) | Cellular atrophy of the cells in the outer and middle ear. |
| D) | Age-related deterioration of the neural pathways associated with hearing acuity. |
| Ans: | A |
| Feedback: | |
| Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph. Cognitive changes, cellular changes in the outer and middle ear, and deterioration of neural pathways are less likely to be implicated. |
| Origin: Chapter 5- Common Aging Changes, 11
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 52, Cells |
|
| 11. | It is important to measure and record fluid input and output accurately because this information is used in evaluating a patient’s fluid balance and in planning care and treatment. Dehydration is a significant risk for the elderly because: |
| A) | The number of body cells is less, and fewer cells are functioning in the body. |
| B) | Total body fat as a proportion of the body’s composition increases with age. |
| C) | Cellular solids and bone mass decrease with age affecting the ability to balance. |
| D) | Extracellular fluid remains constant, but intracellular fluid decreases with age. |
| Ans: | D |
| Feedback: | |
| Although all the statements are true, only the loss of intracellular fluid is a cause of increased risk of dehydration. |
| Origin: Chapter 5- Common Aging Changes, 12
Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 64, Thermoregulation |
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| 12. | With aging the skin becomes thinner and more fragile. The thinning of the skin’s subcutaneous fat layer makes older adults more sensitive to: |
| A) | Cold |
| B) | Heat |
| C) | Pain |
| D) | Pressure |
| Ans: | A |
| Feedback: | |
| Subcutaneous fat serves as an insulator. With less of it, the elderly may be more sensitive to cold temperatures. Older adults are less sensitive to pain and pressure because of decreased sensitivity of nerve endings. |
| Origin: Chapter 5- Common Aging Changes, 13
Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 54, Cardiovascular System |
|
| 13. | Each of the blood vessel layers is affected differently by the aging process. Which would a nurse suspect is responsible for a patient’s fibrosis? |
| A) | Tunica intima |
| B) | Tunica media |
| C) | Tunica adventitia |
| D) | Fibrosis is caused by an enlarged heart |
| Ans: | A |
| Feedback: | |
| The tunica intima, the innermost layer, experiences the most direct changes, including fibrosis, calcium and lipid accumulation, and cellular proliferation. The middle layer, the tunica media, undergoes a thinning and calcification of elastin fibers and an increase in collagen, which causes a stiffening of the vessels. The outermost layer, the tunica adventitia, is not affected by the aging process. In the absence of heart disease, heart size changes little with age. |
| Origin: Chapter 5- Common Aging Changes, 14
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 54, Cardiovascular System |
|
| 14. | The heart muscle commonly weakens with age. What is a consequence of this fact? |
| A) | The heart beats faster but pumps with less force. |
| B) | Fatty deposits and other substances clog narrowed coronary vessels. |
| C) | Blood pressure lowers because of systemic vasodilation. |
| D) | The time required for the heart’s diastolic–systolic cycle decreases. |
| Ans: | A |
| Feedback: | |
| The statement in choice B is true, but age-weakened heart muscle is not the cause. Blood pressure may actually rise as an effect of choice B. The opposite of the statement in choice D is true. |
| Origin: Chapter 5- Common Aging Changes, 15
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 54, Cardiovascular System |
|
| 15. | Older adults in good physical condition have cardiac function comparable to younger persons in poor condition. What is the most likely cause of a rise in systolic blood pressure in the elderly? |
| A) | Postural and postprandial hypotension |
| B) | Atherosclerosis in the innermost layer of the blood vessels |
| C) | Impaired baroreceptor function and increased peripheral resistance |
| D) | Cellular proliferation in the tunica intima |
| Ans: | C |
| Feedback: | |
| In the middle layer of blood vessels, impaired baroreceptor function and increased peripheral resistance lead to a rise in systolic blood pressure. Reduced sensitivity of the blood pressure regulation with baroreceptors increases problems with postural hypotension and postprandial hypotension; thus, they are an effect, not a cause. Cells proliferate in the innermost layer of vessels and atherosclerosis develops, but these are not the direct causes of increased systolic pressure. |
| Origin: Chapter 5- Common Aging Changes, 16
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 55, Gastrointestinal System |
|
| 16. | As a person ages, muscle tone decreases throughout the digestive system, causing a slowing movement of food through the esophagus. Delayed esophageal emptying in the elderly increases the risk of: |
| A) | Gastric irritation |
| B) | Aspiration |
| C) | Irritable bowel syndrome |
| D) | Constipation |
| Ans: | B |
| Feedback: | |
| Normal aging does not interfere with mobility through the bowel or bowel action. Gastric irritation results from a higher pH of stomach fluids. Aspiration is a risk associated with a weakened gag reflex, relaxation of the lower esophageal sphincter, and delayed esophageal emptying. |
| Origin: Chapter 5- Common Aging Changes, 17
Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 57, Urinary System |
|
| 17. | Which of the following is the most common urinary problem among men aged 65 years and older? |
| A) | High urinary volume |
| B) | Glucose in the urine |
| C) | Stress incontinence |
| D) | Frequent urination |
| Ans: | D |
| Feedback: | |
| Although all these conditions may occur or coexist, most common is the need for frequent urination associated with enlargement of the prostate gland. This enlargement occurs to some degree in three-fourths of men aged 65 years and older. |
| Origin: Chapter 5- Common Aging Changes, 18
Chapter: 5 Client Needs: D4 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 58, Musculoskeletal System |
|
| 18. | Which of the following is a normal reflex profile for an elderly patient? |
| A) | Knee: normal; arm: absent; abdomen: absent |
| B) | Knee: normal; arm: reduced; abdomen: absent |
| C) | Knee: reduced; arm: normal; abdomen: reduced |
| D) | Knee: reduced; arm: reduced; abdomen: absent |
| Ans: | B |
| Feedback: | |
| Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee. |
| Origin: Chapter 5- Common Aging Changes, 19
Chapter: 5 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 58, Musculoskeletal System |
|
| 19. | Bone fractures are a serious risk to the elderly. Which of the following is a contributing factor? |
| A) | Diminished calcium absorption |
| B) | Shortening of the long bones |
| C) | Formation of points and spurs |
| D) | Deterioration of cartilage surfaces |
| Ans: | A |
| Feedback: | |
| A decrease in calcium absorption in the elderly contributes to the brittleness of the bones, thus increasing the risk of fractures. |
| Origin: Chapter 5- Common Aging Changes, 20
Chapter: 5 Client Needs: D3 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 60, Nervous System |
|
| 20. | A gerontological nursing course syllabus includes the topic of helping elders ambulate safely. The major factor contributing to an increased risk of falls in the elderly is: |
| A) | Decline in brain weight |
| B) | Reduction of blood flow to the brain |
| C) | Flawed response to changes in balance |
| D) | Slowed nerve conduction velocity |
| Ans: | C |
| Feedback: | |
| Although all the statements are true, the major factor increasing the risk of falls is a flawed response to changes in balance. |
| Origin: Chapter 5- Common Aging Changes, 21
Chapter: 5 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 1 Page and Header: 62, Endocrine System |
|
| 21. | A nurse is reviewing thyroid test results of her clients. Which of the following is the most likely thyroid test result for a healthy elderly patient? |
| A) | T4: low; T3: low; thyroid function: low |
| B) | T4: high; T3: normal; thyroid function: high |
| C) | T4: high; T3: normal; thyroid function: low |
| D) | T4: normal; T3: low; thyroid function: normal |
| Ans: | D |
| Feedback: | |
| With normal aging, secretion of thyroid-stimulating hormones (TSH) and the serum concentration of thyroxine (T4) do not change, although there is a significant reduction in triiodothyronine (T3), which is believed to be a result of the reduced conversion of T4 to T3. Overall, thyroid function remains adequate. |
| Origin: Chapter 5- Common Aging Changes, 22
Chapter: 5 Client Needs: D4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 1 Page and Header: 62, Endocrine System |
|
| 22. | Which of the following blood chemistries may indicate diabetes among young adults but not among the elderly? |
| A) | Low blood glucose level |
| B) | High blood glucose level |
| C) | Prolonged hypoglycemia |
| D) | Insufficient release of insulin |
| Ans: | B |
| Feedback: | |
| Although there is a delayed and insufficient release by the β-cells of the pancreas in the elderly, what will show up in a blood chemistry report is an apparently high level of glucose in the blood. Low blood glucose and prolonged hypoglycemia are not indicators of diabetes. |
| Origin: Chapter 5- Common Aging Changes, 23
Chapter: 5 Client Needs: B Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process Objective: 1 Page and Header: 63, Immune System |
|
| 23. | The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is: |
| A) | Decreased serum activity of the thymic hormones |
| B) | Inactivation of varicella-zoster infections |
| C) | Decreased serum concentrations of IgA and IgG |
| D) | High pain sensitivity associated with inflammation |
| Ans: | A |
| Feedback: | |
| Serum activity of the thymic hormones is almost undetectable with age. Serum concentrations of IgA and IgG increase with age. Inflammation often causes minimal pain in the elderly. |
| Origin: Chapter 5- Common Aging Changes, 24
Chapter: 5 Client Needs: C2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication Objective: 2 Page and Header: 64, Personality |
|
| 24. | Older adults may appear rigid in their attitudes because of: |
| A) | Changes in personality that accompany aging |
| B) | Diminished ability to learn new information |
| C) | Physical or mental limitations |
| D) | Decline in morale and self-esteem |
| Ans: | C |
| Feedback: | |
| Personality, learning ability, and morale/self-esteem do not change with age. Seniors may resist change because of their physical or mental limitations—for example, rearranging the furniture when eyesight or mobility is limited. |
| Origin: Chapter 5- Common Aging Changes, 25
Chapter: 5 Client Needs: D2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 3 Page and Header: 57, Urinary System |
|
| 25. | Decreased renal mass and reduced glomerular filtration make it especially important that nurses: |
| A) | Assist elderly patients with frequent toileting |
| B) | Ensure that age-adjusted drug dosages are prescribed |
| C) | Look for signs of urinary tract infections |
| D) | Frequently check urine for glucose |
| Ans: | B |
| Feedback: | |
| The need for frequent toileting is a result of decreased bladder capacity. Weaker bladder muscles increase the risk of urinary tract infections. Tests for glucose in the urine are needed on a case-by-case basis. The need most associated with decreased renal mass and reduced glomerular filtration is age-adjusted drug dosage. |
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