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The nurse suspects that elder abuse may be occurring when a frail older-adult patient with a broken arm is brought to the emergency department by a family member. Which of these actions should the nurse take first?
- A. Notify an elder protective services agency about the possible abuse.
- B. Make a referral for a home assessment visit by the home health nurse.
- C. Have the family member stay in the waiting area while the patient is assessed.
- D. Ask the patient how the injury occurred and observe the family member's reaction.
Correct Answer: C
Rationale: The initial action should be assessment and interviewing of the patient. The patient should be interviewed alone because the patient will be unlikely to give accurate information if the abuser is present. If abuse is occurring, the patient should not be discharged home for a later assessment by a home health nurse. The nurse needs to collect and document physiological data before notifying the elder protective services agency.
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The nurse is admitting an acutely ill older-adult patient to the hospital. Which of the following interventions should the nurse implement during the admission process?
- A. Speak slowly and loudly while facing the patient.
- B. Obtain a detailed medical history from the patient.
- C. Interview the patient before the physical assessment.
- D. Determine whether the patient uses glasses or hearing aids.
Correct Answer: D
Rationale: Assistive devices should be in place before assessing the patient to minimize anxiety and confusion. When a patient is acutely ill, the physical assessment should be accomplished first to detect any physiological changes that require immediate action. Not all older patients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients. To avoid tiring the patient, much of the medical history can be obtained from medical records.
Which information about an older-adult patient who is being assessed by the home health nurse is of most concern?
- A. The patient organizes medications in a marked pillbox 'so I don't forget them.'
- B. The patient uses three different medications for persistent heart and joint problems.
- C. The patient says, 'I don't go on my daily walks since I had pneumonia 3 months ago.'
- D. The patient tells the nurse, 'I prefer to manage my life without much help from others.'
Correct Answer: C
Rationale: Inactivity and immobility lead rapidly to loss of function in older persons. The nurse should develop a plan to prevent further deconditioning and restore function for the patient. Self-management is appropriate for independently living older persons. The use of three medications is not unusual for an older adult. The use of memory devices to assist with safe medication administration is recommended for older persons.
Findings from a health history indicate that the patient takes daily supplements of the antioxidants beta carotene, vitamin C, and vitamin E. This health practice reflects which of the following theories of biological aging?
- A. Free radicals
- B. Crosslinking
- C. Somatic mutation
- D. Telomere-telomerase depletion
Correct Answer: A
Rationale: Free radicals are natural by-products of many normal cellular processes and are also created under the influence of environmental factors such as smog, tobacco smoke, and radiation. Numerous natural protective mechanisms are in place to prevent oxidative damage. Recent research has focused on the roles of various antioxidants, including vitamins C and E, in slowing down the oxidative process and, ultimately, the aging process. The somatic mutation theory focuses on spontaneous mutations. The crosslinking theory is based upon lipids, proteins, CHO, and nucleic acid reactions. The telomere-telomerase depletion theory focuses on the loss of telomeres, repeated sequences at the ends of DNA.
Which nursing actions will the nurse take to assess for possible malnutrition in an older-adult patient?
- A. Observe for depression.
- B. Review laboratory results.
- C. Assess teeth and oral mucosa.
- D. Ask about transportation needs.
- E. Determine food likes and dislikes.
Correct Answer: A,B,C,D
Rationale: The laboratory results, especially albumin levels, may indicate persistent poor protein intake. Transportation impacts patients' ability to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor condition may decrease the ability to chew and swallow. Food likes and dislikes are not necessarily associated with malnutrition.
The nurse is admitting an older-adult patient who is hospitalized with an acute illness. Which of the following interventions should the nurse do first?
- A. Orientate the patient to their room.
- B. Administer the prescribed PRN sedative medication.
- C. Ask the health care provider to order a vest restraint.
- D. Place the patient in a 'geri chair' near the nurse's station for observation.
Correct Answer: A
Rationale: The older adult who moves to a different location needs a thorough orientation to the environment. The nurse should repeatedly reassure the patient that he or she is safe and attempt to answer all questions. The unit should foster patient orientation by displaying large-print clocks, avoiding complex or visually confusing wall designs, clearly designating doors, and using simple bed and nurse-call systems. Physical or chemical restraints may be necessary, but the nurse's first action should be to provide an ongoing and clear physical orientation. There is no indication that the patient needs observation at this time.