OLDER ADULT ISSUES IN HOS[ITALS AND LONG TERM CARE SET COMMUNITY BASED
SETTINGS CH 2
The nurse learns that a patient is prescribed methylnaltrexone. Which other type of medication should the
nurse expect the patient to have been prescribed?
Opioid
Vasodilator
Anticoagulant
Anticholinergic
Rationale
Methylnaltrexone may be prescribed to treat opioid-induced constipation. The nurse expects that the
patient was also prescribed an opioid. Methylnaltrexone is not prescribed to treat adverse effects from
vasodilator, anticoagulant, or anticholinergic medications. p. 11
What is the most common type of elder abuse?
Neglect
Physical
Financial
Emotional
Neglect occurs when a caregiver fails to provide for an older adult’s basic needs and accounts for almost
half of all cases of elder abuse. Physical abuse is the use of physical force that results in bodily injury.
Financial abuse occurs when the older adult’s property or resources are mismanaged or misused and is
more common than physical abuse. Emotional abuse is the use of threats, humiliation, intimidation, and
isolation toward older adults. p. 19
An older patient has an acute change in mental status and is unable to keep track of what is being said.
Which additional assessment finding should cause the nurse to suspect that this patient is experiencing
delirium?
Complaining of nausea
Asking to get out of bed
Asking to talk with the salesman
Adjusting the volume on the television
Asking to talk with the salesman indicates disorganized thinking. This is a criterion within the Confusion
Assessment Method (CAM) that is used to diagnose delirium. Complaining of nausea, asking to get out of
bed, and adjusting the volume on the television are not criteria used to determine the presence of
delirium. p. 18
Which statement regarding depression in older adults is correct?
Depression in older adults is very easy to diagnose.
Primary depression may result due to an increase in serotonin in the brain.
Secondary depression may occur due to cardiac disease.
Depression in older adults has no physical manifestations.
Secondary depression, also known as situational depression, may occur secondary to common illnesses
such as cardiac disease, arthritis, and stroke. Sometimes depression in older adults is not diagnosed by
the primary healthcare provider and remains untreated. Primary depression is a result of the lack of the
neurotransmitter serotonin in the brain. Along with cognitive and affective manifestations, depression in
older adults has physical manifestations as well. p. 9
,What is the fastest-growing subgroup of older adults?
Young old
Middle old
Old old
Elite old
The old old, people aged 85 to 99 years, is the fastest-growing subgroup of older adults. The young old
are people aged 65 to 74 years, and the middle old are people aged 75 to 84 years. The elite old are
people aged 100 years or older. p. 9
What enhances cognitive health?
Gardening
Weight loss
Increased sleep
Physical activity
From a literature review, it was determined that nutrition and physical activity are helpful in optimizing
cognitive health in aging. Gardening, weight loss, and increased sleep were not identified as optimizing
cognitive health in aging. p. 16
What is a typical age-related change that affects drug distribution in older adults?
Reduced ratio of adipose tissue to lean-body mass
Reduced amount of total body water
Increased albumin level
Increased cardiac output
In older adults, the amount of total body water decreases, which affects the distribution of drugs in the
body. Other age-related changes that affect drug distribution include an increase in the ratio of adipose
tissue to lean-body mass, a decrease in the albumin level, and a decrease in cardiac output.
An increase in the ratio of adipose tissue to lean body mass leads to an increase in the storage of lipid-
soluble drugs. This, in turn, leads to a decreased concentration of the drug in plasma but an increased
concentration in tissue. p. 20
An 80-year-old patient reports a fear of falling when moving around at home. What home modifications
can help this patient prevent falls?
Low toilet seat
Handrails
Scatter rugs
Nonslip bathmats
Adequate lighting
Handrails provide support to the older adult while moving around the house and helps the patient balance
the body. Nonslip bathmats prevent falls in the bathroom. Adequate lighting allows the patient to see
better, preventing the patient from tripping over and falling. A raised toilet seat with a grab-bar within reach
makes it easier for the patient to get on and off the toilet. The older patient may trip over scatter rugs lying
on the floor, so they should be avoided. p. 11
, The nurse is teaching a class of older adults about ways to promote their cognitive health. Which
collaborative interventions will be most helpful for them?
Allowing for increased rest and relaxation time
Having solitary times to reminisce about life experiences
Joining a peer group with a common learning goal
Learning a new skill
Meditating for 30 minutes every day
Starting a new physical activity
Cognitive health problems (depression, delirium, and dementia) can be offset by social engagement,
learning a new skill, and physical activity. Increased rest time, meditation, and increased solitude may be
helpful for other aspects of aging but do not benefit the older adult's cognitive capabilities. p. 10
The nurse is teaching an older adult patient's caregiver about how physical aging influences nutrition.
What statement by the caregiver indicates a correct understanding of the teaching?
"Older adults tend to overuse table sugar in their food."
"Older adults tend to use less table salt in their food."
"Very high-calorie foods are required in older adults' diets."
"Diets of older adults must consist primarily of soft semisolid food."
An older adult's ability to taste sweet and salty flavors is diminished, so older adults tend to overuse table
sugar and salt in their diet. Due to reduced metabolic rates, older adults actually require fewer calories to
maintain an ideal body weight. Older adults should not always be given soft semisolid food; variations in
the texture of food substances provide them satisfaction. pp. 10-11
The nurse is caring for an older adult patient receiving antipsychotics. What adverse drug event is most
likely to happen?
Urinary incontinence
Hypoglycemia
Constipation
Tachycardia
The anticholinergic effect of antipsychotic agents in older adults causes constipation and urinary
retention. Antipsychotics such as risperidone and quetiapine cause hyperglycemia. Bradycardia rather
than tachycardia is seen as an adverse event of antipsychotics. p 22
What does the nurse teach the patient who avoids exercise due to fear of physical injury?
Maintain muscle mass with resistance exercises.
Begin an exercise program under the direction of the health care provider.
Improve strength and endurance with aerobic exercise.
Walk for 30 minutes every day.
The nurse should suggest the patient begin an exercise program as advised by the health care provider.
Informing the patient about the importance of resistance exercises and aerobic exercises are additional
teaching. Asking the patient to walk for 30 minutes daily will not help in reducing the patient's fear of
injury. p. 11
SETTINGS CH 2
The nurse learns that a patient is prescribed methylnaltrexone. Which other type of medication should the
nurse expect the patient to have been prescribed?
Opioid
Vasodilator
Anticoagulant
Anticholinergic
Rationale
Methylnaltrexone may be prescribed to treat opioid-induced constipation. The nurse expects that the
patient was also prescribed an opioid. Methylnaltrexone is not prescribed to treat adverse effects from
vasodilator, anticoagulant, or anticholinergic medications. p. 11
What is the most common type of elder abuse?
Neglect
Physical
Financial
Emotional
Neglect occurs when a caregiver fails to provide for an older adult’s basic needs and accounts for almost
half of all cases of elder abuse. Physical abuse is the use of physical force that results in bodily injury.
Financial abuse occurs when the older adult’s property or resources are mismanaged or misused and is
more common than physical abuse. Emotional abuse is the use of threats, humiliation, intimidation, and
isolation toward older adults. p. 19
An older patient has an acute change in mental status and is unable to keep track of what is being said.
Which additional assessment finding should cause the nurse to suspect that this patient is experiencing
delirium?
Complaining of nausea
Asking to get out of bed
Asking to talk with the salesman
Adjusting the volume on the television
Asking to talk with the salesman indicates disorganized thinking. This is a criterion within the Confusion
Assessment Method (CAM) that is used to diagnose delirium. Complaining of nausea, asking to get out of
bed, and adjusting the volume on the television are not criteria used to determine the presence of
delirium. p. 18
Which statement regarding depression in older adults is correct?
Depression in older adults is very easy to diagnose.
Primary depression may result due to an increase in serotonin in the brain.
Secondary depression may occur due to cardiac disease.
Depression in older adults has no physical manifestations.
Secondary depression, also known as situational depression, may occur secondary to common illnesses
such as cardiac disease, arthritis, and stroke. Sometimes depression in older adults is not diagnosed by
the primary healthcare provider and remains untreated. Primary depression is a result of the lack of the
neurotransmitter serotonin in the brain. Along with cognitive and affective manifestations, depression in
older adults has physical manifestations as well. p. 9
,What is the fastest-growing subgroup of older adults?
Young old
Middle old
Old old
Elite old
The old old, people aged 85 to 99 years, is the fastest-growing subgroup of older adults. The young old
are people aged 65 to 74 years, and the middle old are people aged 75 to 84 years. The elite old are
people aged 100 years or older. p. 9
What enhances cognitive health?
Gardening
Weight loss
Increased sleep
Physical activity
From a literature review, it was determined that nutrition and physical activity are helpful in optimizing
cognitive health in aging. Gardening, weight loss, and increased sleep were not identified as optimizing
cognitive health in aging. p. 16
What is a typical age-related change that affects drug distribution in older adults?
Reduced ratio of adipose tissue to lean-body mass
Reduced amount of total body water
Increased albumin level
Increased cardiac output
In older adults, the amount of total body water decreases, which affects the distribution of drugs in the
body. Other age-related changes that affect drug distribution include an increase in the ratio of adipose
tissue to lean-body mass, a decrease in the albumin level, and a decrease in cardiac output.
An increase in the ratio of adipose tissue to lean body mass leads to an increase in the storage of lipid-
soluble drugs. This, in turn, leads to a decreased concentration of the drug in plasma but an increased
concentration in tissue. p. 20
An 80-year-old patient reports a fear of falling when moving around at home. What home modifications
can help this patient prevent falls?
Low toilet seat
Handrails
Scatter rugs
Nonslip bathmats
Adequate lighting
Handrails provide support to the older adult while moving around the house and helps the patient balance
the body. Nonslip bathmats prevent falls in the bathroom. Adequate lighting allows the patient to see
better, preventing the patient from tripping over and falling. A raised toilet seat with a grab-bar within reach
makes it easier for the patient to get on and off the toilet. The older patient may trip over scatter rugs lying
on the floor, so they should be avoided. p. 11
, The nurse is teaching a class of older adults about ways to promote their cognitive health. Which
collaborative interventions will be most helpful for them?
Allowing for increased rest and relaxation time
Having solitary times to reminisce about life experiences
Joining a peer group with a common learning goal
Learning a new skill
Meditating for 30 minutes every day
Starting a new physical activity
Cognitive health problems (depression, delirium, and dementia) can be offset by social engagement,
learning a new skill, and physical activity. Increased rest time, meditation, and increased solitude may be
helpful for other aspects of aging but do not benefit the older adult's cognitive capabilities. p. 10
The nurse is teaching an older adult patient's caregiver about how physical aging influences nutrition.
What statement by the caregiver indicates a correct understanding of the teaching?
"Older adults tend to overuse table sugar in their food."
"Older adults tend to use less table salt in their food."
"Very high-calorie foods are required in older adults' diets."
"Diets of older adults must consist primarily of soft semisolid food."
An older adult's ability to taste sweet and salty flavors is diminished, so older adults tend to overuse table
sugar and salt in their diet. Due to reduced metabolic rates, older adults actually require fewer calories to
maintain an ideal body weight. Older adults should not always be given soft semisolid food; variations in
the texture of food substances provide them satisfaction. pp. 10-11
The nurse is caring for an older adult patient receiving antipsychotics. What adverse drug event is most
likely to happen?
Urinary incontinence
Hypoglycemia
Constipation
Tachycardia
The anticholinergic effect of antipsychotic agents in older adults causes constipation and urinary
retention. Antipsychotics such as risperidone and quetiapine cause hyperglycemia. Bradycardia rather
than tachycardia is seen as an adverse event of antipsychotics. p 22
What does the nurse teach the patient who avoids exercise due to fear of physical injury?
Maintain muscle mass with resistance exercises.
Begin an exercise program under the direction of the health care provider.
Improve strength and endurance with aerobic exercise.
Walk for 30 minutes every day.
The nurse should suggest the patient begin an exercise program as advised by the health care provider.
Informing the patient about the importance of resistance exercises and aerobic exercises are additional
teaching. Asking the patient to walk for 30 minutes daily will not help in reducing the patient's fear of
injury. p. 11
