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You are the nurse caring for an 85 -year-old patient who has been hospitalized for a fractured radius. The patients daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin, which has become susceptible to cracking and shearing. What would be your best response?
- A. He should likely take showers rather than baths, if possible.
- B. Make sure that he applies sunscreen each morning.
- C. Dry skin is an age-related change that is largely inevitable.
- D. Try to help your father increase his intake of dairy products.
Correct Answer: A
Rationale: Showers are less drying than hot tub baths. Sun exposure should indeed be limited, but daily application of sunscreen is not necessary for many patients. Dry skin is an age-related change, but this does not mean that no appropriate interventions exist to address it. Dairy intake is unrelated.
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Based on a patients vague explanations for recurring injuries, the nurse suspects that a community-dwelling older adult may be the victim of abuse. What is the nurses primary responsibility?
- A. Report the findings to adult protective services.
- B. Confront the suspected perpetrator.
- C. Gather evidence to corroborate the abuse.
- D. Work with the family to promote healthy conflict resolution.
Correct Answer: A
Rationale: If neglect or abuse of any kind including physical, emotional, sexual, or financial abuse is suspected, the local adult protective services agency must be notified. The responsibility of the nurse is to report the suspected abuse, not to prove it, confront the suspected perpetrator, or work with the family to promote resolution.
You are the nurse caring for a 91-year-old patient admitted to the hospital for a fall. The patient complains of urge incontinence and tells you he most often falls when he tries to get to the bathroom in his home. You identify the nursing diagnosis of risk for falls related to impaired mobility and urinary incontinence. The older adults risk for falls is considered to be which of the following?
- A. The result of impaired cognitive functioning
- B. The accumulation of environmental hazards
- C. A geriatric syndrome
- D. An age-related health deficit
Correct Answer: C
Rationale: A number of problems commonly experienced by the elderly are becoming recognized as geriatric syndromes. These conditions do not fit into discrete disease categories. Examples include frailty, delirium, falls, urinary incontinence, and pressure ulcers. Impaired cognitive functioning, environmental hazards in the home, and an age-related health deficit may all play a part in the episodes in this patients life that led to falls, but they are not diagnoses and are, therefore, incorrect.
An 84-year-old patient has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The patient is oriented to name only. The patients family is very upset because, before having surgery, the patient had no cognitive deficits. The patient is subsequently diagnosed with postoperative delirium. What should the nurse explain to the patients family?
- A. This problem is self-limiting and there is nothing to worry about.
- B. Delirium involves a progressive decline in memory loss and overall cognitive function.
- C. Delirium of this type is treatable and her cognition will return to previous levels.
- D. This problem can be resolved by administering antidotes to the anesthetic that was used in surgery.
Correct Answer: C
Rationale: Surgery is a common cause of delirium in older adults. Delirium differs from other types of dementia in that delirium begins with confusion and progresses to disorientation. It has symptoms that are reversible with treatment, and, with treatment, is short term in nature. It is patronizing and inaccurate to reassure the family that there is nothing to worry about. The problem is not treated by the administration of antidotes to anesthetic.
A nurse is caring for an 86-year-old female patient who has become increasingly frail and unsteady on her feet. During the assessment, the patient indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this patient is at a high risk for what health problem?
- A. A hip fracture
- B. A femoral fracture
- C. Pelvic dysplasia
- D. Tearing of a meniscus or bursa
Correct Answer: A
Rationale: The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture.
Older people have many altered reactions to disease that are based on age-related physiological changes. When the nurse observes physical indicators of illness in the older population, that nurse must remember which of the following principles?
- A. Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population.
- B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults.
- C. The same physiological processes that indicate serious health care problems in a younger population indicate mild disease states in the elderly.
- D. Middle-aged people do not react to disease states the same as a younger population does.
Correct Answer: B
Rationale: Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. Option A is incorrect because a potentially life-threatening problem in an older person is more serious than it would be in a middle-aged person because the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered mild in the elderly population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question.