Ebersole and Hess Gerontological Nursing and Healthy Aging 4e by Touhy Jett Test bank

Ebersole and Hess Gerontological Nursing and Healthy Aging  4e by Touhy Jett  Test bank
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Chapter 5: Theories of Aging and Physical Changes
Test Bank

MULTIPLE CHOICE

1. Name the theory of aging that suggests that the adverse physical effects of aging are the result of a gradual loss of control mechanisms in the pituitary and hypothalamus.
a.
Free-radical theory
c.
Stochastic theory
b.
Programmed theory
d.
Neuroendocrine theory

ANS: D
The neuroendocrine theory attributes aging to gradual changes in or the loss of the mechanisms that control the organs through chemical signals. The free-radical theory attributes aging to the accumulation of destructive products of metabolic oxidation. The programmed theory attributes aging to cells exhausting a predetermined number of replications. A stochastic theory attributes aging to the accumulation of random damage to DNA and other molecules.

PTS: 1 DIF: Remember REF: 5
TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. Decreased functioning of which physical structure is likely to result in decreased metabolism in older adults?
a.
Kidney
c.
Brain
b.
Thyroid gland
d.
Skeleton

ANS: B
Secretion of thyroid hormones tends to decrease with age, resulting in a greater likelihood of a slower metabolism, hypothyroidism, and thinning hair and nails. Decreased kidney function leads to decreased glomerular filtration rate and the ability of the kidneys to concentrate urine and clear waste. Decreasing brain function tends to result in decreased cognitive functioning. Osteoclastic activity tends to decrease with age, increasing the risk for osteopenia and osteoporosis.

PTS: 1 DIF: Understand REF: 18
TOP: Nursing Process: Assessment MSC: Physiological Integrity

3. An older female patient is reading a large-print magazine and states that reading is difficult for her in the evening. Which intervention should the nurse implement?
a.
Put a high-intensity lamp at the head of her bed.
b.
Explain to her that the gray-yellow ring around her cornea, arcus senilis, is interfering with visual acuity.
c.
Put more powerful tubes in the fluorescent room lights.
d.
Examine her retinas for signs of damage.

ANS: A
The pupil becomes gradually smaller with age; therefore the eye requires three times as much light. A high-intensity light on the object of interest is more effective than increasing the overall room illumination. The arcus senilis does not affect vision. The patient is describing a gradual overall change, not the more localized or sudden effects of macular degeneration or retinal detachment.

PTS: 1 DIF: Apply REF: 26
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

4. Aging ordinarily leads to decreases in which of the following?
a.
Creatinine clearance and insulin secretion
b.
Blood carbon dioxide and saliva production
c.
Left ventricle-wall thickness and skin healing time
d.
Serum triiodothyronine (T3) and gastric pepsin

ANS: D
Serum T3 and pepsin secretion both decrease with aging. Creatinine clearance declines, but insulin secretion normally remains stable. Saliva production decreases, but blood carbon dioxide normally remains unchanged. Left ventricle-wall thickness and skin healing time both increase with aging.

PTS: 1 DIF: Understand REF: 18
TOP: Nursing Process: Assessment MSC: Physiological Integrity

5. Which change in the skin is abnormal in an older person?
a.
Thinner and more fragile skin
c.
Greater number of freckles
b.
Red, swollen 3-day-old wound
d.
Loss of hair on the extremities

ANS: B
Although the skin of an older person may require 48 to 72 hours to mount an initial inflammatory response to a wound, increasing redness after that time, particularly with purulent discharge, is a sign of infection. This change is normal as ridges in the skin are lost. Melanin distribution becomes more uneven with age. Hair is commonly lost from the legs and other areas of older adults. Hair loss from the legs is not a sign of peripheral vascular disease.

PTS: 1 DIF: Understand REF: 7
TOP: Nursing Process: Assessment MSC: Physiological Integrity

6. The nurse designs a group exercise program at a senior center. Which room should the nurse choose for the program?
a.
Room with a beautiful hardwood floor tastefully appointed with throw rugs
b.
Spacious room with no windows but with fluorescent lighting and a natural stone floor
c.
Room with a hardwood floor and large windows overlooking a garden area
d.
End room with a linoleum floor and a fan for ventilation to compensate for the rooms broken air conditioner

ANS: C
The hardwood floor provides an even surface. If the daylight from the large windows causes a glare problem, then curtains may be used. Throw rugs can slide underfoot and can lead to a fall, particularly when the sense of balance has declined with age. The fluorescent lighting can lead to a glare problem, and the irregularities of the natural stone floor can lead to a fall. The linoleum floor also presents a glare problem, and overheating is a risk in older persons who have a reduced sweat-gland response to heat.

PTS: 1 DIF: Apply REF: 27
TOP: Nursing Process: Assessment MSC: Physiological Integrity

7. The latest trends in medicine encourage health care providers to prescribe nutrient-dense foods and exercise to prevent or delay the shortening of telomeres. On which biological theory of aging are these practices based?
a.
Genetic research
c.
Pacemaker theory
b.
Caloric restriction
d.
Cross-link theory

ANS: A
Genetic researchers have found that telomeres shorten with each cellular reproduction and continue to do so until the cell dies. Selected animal studies since the 1930s conclude that calorie restrictions of 30% can lead to a longer life expectancy, slower metabolism, lower body temperature, and delay of age-related disorders. The pacemaker theory, which is also known as the neuroendocrine control theory, holds that critical functions of selected endocrine glands slow and can halt with age. The cross-link theory suggests that aging is a result of the stiffening of proteins caused by cross-linking, leading to stiffer joints, rougher skin, and decreased cellular elasticity.

PTS: 1 DIF: Understand REF: 41-42
TOP: Nursing Process: Assessment MSC: Physiological Integrity

8. During a nursing assessment, an older adult tells the nurse about increasing loss of balance. Further assessment indicates musculoskeletal changes. Which patient teaching should the nurse implement to address musculoskeletal reasons for the loss of balance?
a.
Exercise with light weights.
b.
Stand on one foot at a time while supported.
c.
Train with the use of sit-ups.
d.
Work out in a swimming pool.

ANS: B
The loss of balance from a musculoskeletal perspective is usually due to a loss of core muscle strength, thus the nurse suggests standing on one foot at a time while holding onto a chair back, if necessary, and working to increase the duration of the exercise. Lifting weights helps increase muscle strength. Sit-ups are contraindicated for older adults because they put tremendous amounts of stress on the lumbar spine. Low-impact aerobic exercise helps improve conditioning and endurance.

PTS: 1 DIF: Apply REF: 11-12| 24-25
TOP: Nursing Process: Implementation MSC: Teaching/Learning

9. The nurse cares for an older adult who has a prealbumin level of 10 mg/dl and an infection in a large wound. Which intervention is the nurses priority?
a.
Monitor temperature and leukocytes.
b.
Provide assistance with meal planning.
c.
Provide high-quality protein in the diet.
d.
Maintain oxygen saturation above 95%.

ANS: D
The nurses priority is to maintain oxygen saturation above 95% to help provide oxygen that the heart is unable to provide. The heart of this older adult is less able to respond to increased oxygen demands from infection because of age-related changes in the myocardium including ventricular hypertrophy and decreased coronary blood flow and changes in pulmonary function. Further, because this older adult is malnourished and thus likely to have anemia, any capacity to meet increased oxygen demand is stymied. Along with airway, breathing and circulation are two of the three most basic needs. Similarly, the older heart may not be able to respond to other calls for increased cardiac demand such as infection, anemia, pneumonia, cardiac dysrhythmias, surgery, diarrhea, hypoglycemia, malnutrition, and drug-induced and noncardiac illnesses such as renal disease and prostatic obstruction.
Monitoring temperature and leukocytes is important to implement for anyone with an infection, but it is not as important as breathing and circulation. Besides, fever is an unreliable indicator of infection in an older adult. Providing assistance with meal planning is a reasonable nursing intervention, but it is not as important as breathing and circulation. The nurse provides high-quality protein in this individuals diet because of malnutrition, but this teaching is not as important as breathing and circulation.

PTS: 1 DIF: Analyze REF: 15
TOP: Nursing Process: Implementation MSC: Physiological Integrity

10. An older man who paints houses for a living has had a myocardial infarction (MI). Which intervention should the nurse implement to prevent adverse health effects from his occupational history?
a.
Provide low-cholesterol diet meals.
b.
Avoid substances that are hepatotoxic.
c.
Promote coughing and deep breathing.
d.
Analyze the electrocardiograms rhythm.

ANS: C
The nurse implements coughing and deep breathing because of the older mans history of exposure to environmental toxins from the paint vapor. Therefore to promote oxygenation and ventilation and to prevent atelectasis and pneumonia, the nurse instructs him to cough and deep breathe at regular intervals. Hypercholesterolemia is a common co-morbidity with coronary artery disease; if his total cholesterol is greater than 200 mg/dl, then the nurse should provide a low-cholesterol diet. Inhalation of paint vapor over a long period has adverse effects primarily on the lungs. However, some hepatotoxic substances are used in health care, such as immunosuppressants and aminoglycoside antibiotics, and must be given to this individual with caution. Because he had a MI, the nurse closely monitors the hearts rhythm to detect ventricular dysrhythmias, tachycardia, and other potentially harmful rhythms, but such abnormal rhythms are unlikely to be directly related to his occupational history.

PTS: 1 DIF: Apply REF: 15
TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

11. The nurse administers an antibiotic and naproxen to an older woman. Which laboratory test result should the nurse monitor to gauge the older adults response to the medication?
a.
Urine creatinine
c.
Serum creatinine
b.
Indirect bilirubin
d.
Total hemoglobin

ANS: A
Antibiotics and nonsteroidal antiinflammatory agents such as naproxen can cause kidney damage from various mechanisms; thus the nurse monitors the urine creatinine because it reflects the systems ability to clear waste products and is especially important for gauging appropriate medication administration. Unconjugated (indirect) bilirubin reflects the livers ability to conjugate serum bilirubin. Serum creatinine, also a reflection of renal function, usually remains stable throughout life. Older adults may have changes in hemoglobin and erythrocyte synthesis caused by changes in iron and vitamin B12 absorption.

PTS: 1 DIF: Apply REF: 16-17 TOP: Nursing Process: Planning
MSC: Physiological Integrity

12. An older adult who recently had surgery complains of pain at the level of 3 out of 10 and constipation during the postoperative primary care visit. Which intervention should the nurse implement to first facilitate elimination?
a.
Encourage the use of a laxative.
c.
Promote fiber in the diet.
b.
Review the medication list.
d.
Suggest added fluid intake.

ANS: B
The nurse begins by reviewing the medication list to find substances that are likely to cause constipation such as opioid analgesics and antidepressants, among others. If the patient is taking an opioid analgesic and because the patient rates the pain as 3 out of 10, then a change in pain medication can help relieve constipation. The use of a laxative can be contraindicated and is the therapy of last resort for constipation caused by factors other than opioid analgesics. Promoting fiber in the diet is a reasonable intervention but can be made unnecessary by omitting the opioid analgesic. Increasing fluid intake is a reasonable nursing intervention for older adults with and without constipation, but it can be unnecessary for this older adult.

PTS: 1 DIF: Analyze REF: 22
TOP: Nursing Intervention: Planning MSC: Health Promotion and Maintenance

13. Which age-related change contributes to anorexia and weight loss in the older adult?
a.
Excessive saliva
c.
Wearing dentures
b.
Fewer taste buds
d.
Softened tooth enamel

ANS: B
The number of taste buds declines with age and can decrease the enjoyment of food, which can result in less motivation to eat and a resulting weight loss or loss of appetite. Saliva production tends to decrease with age. As long as dentures fit properly and the wearer practices good oral hygiene, wearing dentures does not necessarily contribute to anorexia and weight loss. Older adults tend to lose enamel.

PTS: 1 DIF: Remember REF: 20
TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

14. The nurse assigns the diagnosis of Nutrition Imbalance: less than body requirements for an older adult. Which age-associated intestinal problem does the nurse apply to plan goals and interventions to improve this adults nutritional status?
a.
Less intrinsic factor secretion
c.
Decreased gastric smooth muscle
b.
Short, broad small intestinal villi
d.
Decreased large intestinal motility

ANS: B
Villi of the small intestine shorten and widen with age and, as a result, become less functional, which contributes to malabsorption of nutrients; despite a healthy diet, nutrients are absorbed primarily in the small intestines. The concept of malabsorption is what the nurse uses to plan care; this nursing diagnosis refers to the inability of the body to absorb nutrients as a result of biological factors. Decreased intrinsic factor secretion leads to pernicious anemia as a result of the inability to absorb vitamin B12 in the stomach. Gastric smooth muscle is not present in the intestines. Decreased large intestine motility is an age-associated problem; however, it should have no impact on absorption in the small intestine.

PTS: 1 DIF: Apply REF: 22 TOP: Nursing Process: Planning
MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which factor(s) associated with aging contribute(s) to the high incidence of type 2 diabetes mellitus in older adults? (Select all that apply.)
a.
Fewer T-lymphocytes
b.
Less lean muscle mass
c.
Decreased thyroid function
d.
Decreased physical activity
e.
Left ventricular hypertrophy
f.
Decreased insulin sensitivity

ANS: B, C, D, F
Less lean muscle mass means that the body has fewer insulin receptor sites; thus glucose circulates in the blood stream longer, leading to hyperglycemia and type 2 diabetes mellitus. Decreased thyroid function decreases the metabolic rate. If the metabolic rate decreases without a corresponding decrease in caloric intake, then the body consumes more food than it needs for its metabolic rate and hyperglycemia occurs. Decreased physical activity contributes to type 2 diabetes in two ways. First, a less active person has less lean muscle mass than an active person. Second, physical activity helps metabolize glucose; if activity decreases and food consumption does not decrease, then hyperglycemia occurs. Insulin sensitivity decreases with age and increases the need for insulin in older adults. To prevent hyperglycemia, the older adult must increase physical activity and decrease food consumption.
Fewer T-lymphocytes are associated with age-related changes caused by autoimmune reactions wherein the body recognizes itself as a foreign substance and works to destroy it. Type 1 diabetes mellitus is considered an autoimmune disorder. Left ventricular hypertrophy is not directly related to the increased incidence of type 2 diabetes in older adults; however, if hypertrophy leads to exercise intolerance, then it can be related to an increased incidence of type 2 diabetes.

PTS: 1 DIF: Understand REF: 17-18
TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. During a walk, an older man suffers a laceration from a broken tree branch. Rank the nurses interventions in order, beginning with the most important intervention.
a.
Flush and cleanse the wound well.
b.
Investigate a possible safety hazard.
c.
Instruct him to keep the wound covered.
d.
Verify a current tetanus immunization.

ANS: A, B, C, D
Flushing and cleansing the wound helps prevent the invasion of potential pathogens from the tree into the mans system. This most basic nursing intervention is the nurses first priority because it helps maintain physiological functioning. Without the wound being clean, the remaining nursing interventions cannot be effective. The second most important task for the nurse is to instruct the patient to keep the wound covered; the inflammatory response can take 48 to 72 hours to begin in an older adult. Covering the wound will help keep the wound clean and prevent contamination. Without the action of the bodys defense mechanisms at the wound in an older adult, inflammatory mediators remain inactive, allowing potential pathogens to remain unchecked, increasing the risk for infection. The third most important task is for the nurse to ensure that the older adult has a current tetanus immunization; tetanus is associated with breaks in the skin. The lowest-priority task for the nurse is to ensure the broken tree branch does not present a safety hazard; therefore the nurse questions the older adult for additional information and takes any necessary action to prevent another accident.

PTS: 1 DIF: Analyze REF: 29 TOP: Nursing Process: Planning
MSC: Physiological Integrity

3. The Healthy People 2020 document identified which goals for immunizations?
a.
Increase percentage of persons who receive a seasonal influenza immunization; 65 years of age or over and living in the community
b.
Increase percentage of persons who are vaccinated against herpes zoster, 60 years of age or over
c.
Increase percentage of persons who are vaccinated against pneumococcal disease; 65 years of age or over and living in the community
d.
Increase percentage of persons who are vaccinated against human papillomavirus (HPV); 60 years of age or over

ANS: A, B, C
According to the Healthy People 2020 document, the goals are to increase the percentage of persons who receive a seasonal influenza immunization; 65 years of age or over and living in the community; to increase the percentage of persons who are vaccinated against herpes zoster, 60 years of age or over; and to increase the percentage of persons who are vaccinated against pneumococcal disease; 65 years of age or over and living in the community. Increasing the percentage of persons vaccinated against HPV, 60 years of age or over, is not a goal. After age 27 years, an immunization for HPV is not recommended.

PTS: 1 DIF: Understand
REF: 40-41 Healthy People 2020 Goals for Immunization Box
TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. When caring for an older man patient, the nurse is aware that which changes are associated with the male reproductive system and aging? (Select all that apply.)
a.
Testes soften
c.
Sperm count decreases
b.
Seminiferous tubules thicken
d.
Ejaculation is slower

ANS: A, B, D
Although men have the ability to produce sperm throughout their lives, they also experience changes in the functioning of the reproductive and the urogenital organs in later life. The changes are usually more subtle and noticed only as they accumulate, beginning when men are in their 50s. The testes atrophy and soften. The seminiferous tubules thicken, and obstruction caused by sclerosis and fibrosis can occur. Although sperm count does not decrease, fertility may be reduced because of a higher number of sperm lack motility or have structural abnormalities. Erectile changes are also seen; more stimulation is needed to achieve a full erection, ejaculation is slower and less forceful, and refractory periods are longer.

PTS: 1 DIF: Understand REF: 19
TOP: Nursing Process: Assessment MSC: Physiological Integrity

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