The nurse is reviewing a laboratory report for a 61-year-old...

The nurse has limited time to teach the middle-aged adult client. The nurse should initially plan to take which action?

A. Provide brochures and handouts that the client can discuss with family members
B. Make a referral to outpatient resources for the client to receive the needed teaching
C. Establish the highest-priority learning needs and teach with each client or family contact
D. Answer the client’s questions and leave the extensive teaching for the nurse on the next shift

Correct Answer: C

Rationale: Prioritizing learning needs ensures important teaching is completed efficiently during limited time. Brochures alone, referrals, or deferring teaching are less effective initially.

The nurse is collecting information from the young adult client. Which psychosocial questions should the nurse ask during the admission assessment? Select all that apply.

A. Do you have any pets?'
B. How many hours of sleep do you get?'
C. When was your last bowel movement?'
D. How much alcohol do you drink?'
E. Can you describe your sexual activity?'

Correct Answer: A;B;D;E

Rationale: The nurse should ask about pets (enhances mental well-being), sleep (affects coping and immunity), alcohol use (impacts health risks), and sexual activity (STI/HIV risks). Bowel movement is physiological, not psychosocial.

The nurse is interviewing an 80-year-old client who has urinary incontinence. The client is taking furosemide. When asked about daily fluid intake, the client states, 'I drink 2 glasses of water, 1 glass of milk, and a half glass of juice. I don’t drink coffee or tea.' Which responses by the nurse are appropriate? Select all that apply.

A. Your fluid intake should be 6 to 8 glasses of water, plus other fluids.'
B. Your fluid intake is adequate and may help to reduce your incontinence.'
C. Caffeine increases urination; it is good that you avoid drinking coffee.'
D. Your fluid intake is limited; this increases your risk for dehydration.'
E. Your fluid intake is sufficient to maintain a fluid and electrolyte balance.'

Correct Answer: A;C;D

Rationale: The client’s 3.5 glasses of fluid are inadequate, increasing dehydration risk, especially with furosemide. Older adults need 6-8 glasses of water plus other fluids, and avoiding caffeine reduces diuresis. Inadequate fluid may worsen incontinence.

The nurse is assessing the 50-year-old female client who is hospitalized. The nurse should assess the client for which physical changes associated with aging? Select all that apply.

A. Increased sweat gland activity
B. Decreased ability to read smaller print
C. Weight loss due to hypermetabolism
D. Increased sebaceous gland activity
E. Absence of a menstrual cycle

Correct Answer: B;E

Rationale: Visual acuity declines, affecting near vision, and menopause causes absence of menstruation in middle-aged women. Sweat and sebaceous gland activity decrease, and weight gain, not loss, occurs due to slower metabolism.

The nurse is caring for the chronically ill middle-aged adult who has had numerous hospitalizations. Which behaviors may interfere with the client’s achievement of the developmental task associated with middle adulthood? Select all that apply.

A. Writes thank-you notes to friends
B. Stays at home and refuses visitors
C. Self-absorbed in own psychological needs
D. Attempts to perform own personal cares
E. Continually relays feelings of inadequacy

Correct Answer: B;C;E

Rationale: Staying home, self-absorption, and feelings of inadequacy interfere with maintaining social relationships and generativity. Thank-you notes and self-care support generativity.

NCLEX Questions on Older Adults Related

Correct Answer: D