HESI PN Gerontology Exam Question and Answers & Study Guide

HESI PN GERONTOLOGY EXAM QUESTIONS AND ANSWERS & STUDY GUIDE • Healthy aging is now an achievable goal for many. • Aging and disease are separate entities. • Aging is an individual process that affects each person differently. • The chronologic age of 65 is the standard in the United States for being considered an older adult (elderly). • By 2050, one in five Americans will be over the age of 65. • The concept of aging is further defined as young-old (65 to 74), middle-old (75 to 84), old-old (over 85), elite-old (over 90), centenarian (over 100), and super-centenarian (110 and over). • Eighty percent of people over the age of 70 have at least one chronic condition, and 50% have multiple health problems. Theories of Aging 1. Psychosocial Theories: a. Disengagement Theory: Progressive social disengagement occurs naturally with aging and is accepted by the older adult. Variation in disengagement across older populations is related to cultural style and behaviors in different geographic regions. b. Activity Theory: Successful again requires a high level of activity and involvement to maintain life satisfaction and positive self – esteem. 2. Biologic Theories: a. Pacemaker Theory: A programmed decline or cessation of many concepts occurs in the nervous and endocrine systems. b. Immunity Theory: A programmed accumulation of damage and decline of the immune systems’ function (immunosenescence) takes place due to oxidative stress. c. Wear-and-Tear Theory: After repeated use, damaged cells in the body structures wear out from the harmful effects of internal and external stressors, now known as free radicals. 3. Developmental Theories: a. Erik Erikson’s Theory: Theory identifies 8 stages of developmental tasks throughout the life span; 8th stage is integrity versus despair b. Maslow’s Theory: Maslow’s hierarchy of needs ranks an individual’s needs from the most basic to the most complex. Maslow uses the terms physiologic, safety and security, belonging, self-esteem, and self-actualization needs to describe the process that generally motivates individuals to move through life. HINT: The concept of aging is shifting from viewing older adults as frail and dependent to being able to engage in healthy living. The majority of those aged 65 and older regard their health as good or excellent. The ability to perform activities of daily living (ADLs) is a more accurate measure of an older person’s age than chronologic age. Physiologic Changes • Aging effects every cell in every organ of the body, but not at the same rate • Three physiologic changes are clinically significant in making older adults vulnerable to injury & disease: o Loss in compensatory reserve (making up for a loss in physiological compensation; vital signs) o Progressive loss in efficiency of the body to repair damaged tissue o Decreased functioning of the immune system processes • Diseases in older adults do not always present with classic signs and symptoms • Physiologic changes increase more rapidly with increasing age • Aging changes are influenced by genetic makeup & environment HINT: Questions may ask about teaching and designing rehabilitation programs for older adults. The answers should contain information about exercise and nutrition. Integumentary System: Skin, hair, and nail changes occur with aging and can cause problems concerning discomfort and self-esteem. • Thin Skin provides a less effective barrier to trauma due to a loss of subcutaneous tissue. o Increased risk for dehydration due to decline in lean mass & loss of body water o Decreased ability of the skin to detect and regulate temperature o Dry skin resulting from a decrease in endocrine secretion o Loss of elastin & increased vascular fragility • Keratinocytes become smaller and regeneration slows; wound healing is slower. • Hair loss occurs; women have increased facial hair • Vascular hyperplasia causes more varicosities (brown or blue discolorations) • Increased appearance of “age spots” and/or “liver spots” and raised lesions (seborrheic keratosis) • Nails becomes brittle & thick. Nursing Assessment 1. Skin dryness & tears 2. Nails for changes in shape, color, and brittleness 3. Lesions to differentiate normal from abnormal; 4. Bony prominences for signs of pressure ulcers Nursing Plans & Interventions A. Encourage the use of oils or lubricants on the skin at least twice a day. B. Discourage the use of powder, which can be drying. C. Teach to avoid overexposure to sunlight. D. Encourage balanced nutrition and increased fluid intake. E. Teach to maintain adequate humidity in the environment. F. Teach to avoid temperature extremes. G. Teach good foot care. H. Observe bony prominences for signs of pressure. I. Teach that poor peripheral circulation may slow the healing of foot and hand lesions. HINT: The Exam will test your ability to differentiate normal and pathologic causes of skin and hair conditions; for example, the differences between seborrheic keratosis and melanoma Musculoskeletal System: Age-related changes in the musculoskeletal system are gradual but have a significant impact on levels of mobility, which puts older adults at risk for falls and fractures. • The Musculoskeletal system is composed on bones, joints, tendons, ligaments, and muscles. • Age – related changes are not life threatening, but can affect function & quality of life. • Bone loss begins around age 40 and is more common in women than in men; thus; osteoporosis occurs more often in women. • Shortening of the trunk (torso) due to thinning of the vertebral disks. • Loss of bone calcium, atrophic (decrease in size) cartilage and muscle occurs. • Bone mineral density (BMD) decreases, resulting in osteopenia and osteoporosis. • Range of motion (ROM) of joint decreases. • Progressive loss of cartilage occurs, resulting in osteoarthritis. • Muscle cells are lost and not replaced. • Lean body mass decreases with increased body fat. Nursing Assessment 1. Dietary intake of calcium and vitamin D 2. Weight; underweight or overweight 3. Lifestyle habits; inappropriate nutrition, smoking, and inadequate exercise 4. History of fractures 5. ROM 6. Pain and chronic pain management strategies 1. The clinic nurse receives a telephone call from the daughter of an older female client. The daughter reports that her mother has a cough and has become confused and short of breath, but only has a temperature of 99.4F. What action should the nurse take? a. Reassure the daughter that these are common signs of upper respiratory tract congestion. b. Advise the daughter to monitor her mother’s temperature and call if it continues to rise higher. c. Tell the daughter to keep her mother well hydrated and encourage rest for the next 48 hours. d. Explain to the daughter that she needs to bring her mother for immediate medical evaluation. 2. The unlicensed assistive personal (UAP) reports to the charge nurse that an older resident of the extended care facility, who has limited mobility, has not had a bowel movement in 5 days. Which action should the nurse take first? a. Check bowel sounds and abdominal tenderness b. Increase fiber and diet and add daily prune juice c. Perform a digital examination for a fecal impaction 3. An older male client is admitted with hypothermia with a core body temperature of 95F (35C) due to the lack of adequate heat in his home. Which findings should the nurse expect to obtain? (select all that apply) a. Hyperalert state b. Headache c. Cool skin d. Shivering e. Confusion 4. An older adult woman, who cares for her husband at home without assistance, requires minor surgery. With no family members living in the area, the wife expresses concern about her husband’s care while she recovers. Which intervention is likely to be most helpful in this situation? a. Suggest she ask social services to find a respite care facility for the husband 5. During report, an older female client, who had a right total hip replacement three days ago, is described as intolerant of pain. When assessing the client, the nurse finds that the client cannot straighten her right foot, which is pointing outward from her body. Which action should the nurse take? Call healthcare provider immediately 6. An older female sustained a right hip fracture one week ago that was surgically repaired the following day. Today she is reporting left sided leg pain, and the nurse observes edema of the left leg and a positive Homan sign. These findings should be reported to the health care provider because they are indicative of which condition? DVT 7. To help prevent drug interactions, which instruction should the nurse provide an older client who is taking many medications? A. Do not take any over the counter drugs while taking medications prescribed by a healthcare provider (could be this one?) B. Use a medication reminder system to prevent forgetting to take the right medications at the right time (could be this one?) C. Be sure a family member knows the name and use of all medications currently being taken D. Bring all medication supplement and herbs currently being taken to the next clinic appointment (could be this one?) 8. The daughter of a frail, elderly woman brings her mother to the clinic for an annual physical. Which concerns shared by the daughter should the nurse address first? a. The mother is having increasing periods of forgetfulness and mood swings. b. The daughter reports her mother’s bowel movements are hard and infrequent. c. The client lost 10 lbs last month and shows no interest in her personal hygiene. d. The family members are overwhelmed with the responsibility of caring for her mother. 9. When conducting assessments at an assisted living community, the nurse finds that an older adult client who is normally alert, oriented, and continent, is confused and incontinent of urine. Which intervention is MOST important for the nurse to implement? a. Place a protective undergarment on the client b. Obtain a clean, voided urine sample using a urinal hat c. Encourage increased fluid intake for 24 hours d. Evaluate the client’s response to bladder training efforts 10. An older female adult who lives in a nursing home is loudly demanding that the nurse call her son who has been deceased for five years. Which intervention should the nurse implement? Direct the client to a new activity 11. An older adult is admitted to an acute medical unit from a long-term care facility. When reviewing the client’s prescribed medications, which intervention should the nurse implement first? A. Determine which medications may be given in generic form rather than brand name only. B. Provide client teaching regarding the desired effects of the client’s admission prescriptions