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1. Of the following aging theory examples, which one supports the nonstochastic beliefs about aging?
A) Mitochondrial DNA damage has accumulated to such a level that the person has physiological symptoms of declining health.
B) Oxidative free radicals result in by-products that react with DNA to lead to cellular damage.
C) The wear-and-tear theory of aging states that accumulated damage to vital parts of cells leads to cellular aging and death.
D) Mutations in BRCA1 and BRCA2 have been associated with increased risk for developing breast and ovarian cancer.
Nonstochastic theories focus on genetic influences that determine physical condition, occurrence of disease, age of death, cause of death, and other factors contributing to longevity. Many genes that are associated with the human life span are not longevity genes, per se. For example, because mutations in the tumor suppressor genes BRCA1 and BRCA2 increase mortality rates associated with breast and ovarian cancer, they are rare among long-lived women. The mitochondrial DNA damage theory, oxidative free radical theory, and wear-and-tear theory are all stochastic theories of aging.
2. A community health nurse is working with an 81-year-old female client who states that she has made a concerted effort throughout her life to protect her skin from the sun and regularly applies topical moisturizers. The client is lamenting the fact that her skins appearance has nonetheless deteriorated in recent years. Which of the following statements best captures a fact that the nurse should take into consideration when crafting a response to the client?
A) The epidermal layer of the skin inevitably thins as part of the normal aging process, lending a transparent appearance to the skin.
B) Skin becomes weaker and less elastic in older adults because of the rearrangement of fibrin and keratin.
C) Skin becomes more fragile and prone to hematomas because of impaired vascularity.
D) Output of sebaceous glands declines, with accompanying reductions in sweat production.
Impaired vascularity and cellularity cause the skin of older adults to be prone to subcutaneous bleeding, resulting in senile purpura. The dermal, rather than epidermal, layer becomes thinner, and weakness is a result of collagen rearrangement rather than fibrin. Sebaceous glands produce sebum not sweat.
3. A physiotherapist (PT) at an assisted living facility for older adults is leading an exercise class for the residents. Part of the PTs introductory class is an explanation of the health problems that can be mitigated by physical activity and those that are considered inevitabilities of the aging process. Which of the following phenomena would the PT most justifiably characterize as modifiable?
A) Reduction in density of the trabecular bone
B) Gradual decline in physical reaction time
C) Overall reduction in muscle strength
D) Decline in height
While a general reduction in muscle strength is a normal, age-related change, this can be slowed significantly by regular physical activity. Loss of bone density in the trabecular bone, decreases in reaction time, and loss of height are less modifiable.
4. While taking BP for a new geriatric patient, the nurse notes that his BP is 162/70. When questioned by the nurse, the patient states, Thats a pretty good BP for me. My upper number is usually higher. Based on this finding, the nurse should further collect data related to which of the following body systems? Select all that apply.
A) Detailed history surrounding cardiac events like chest pain or pressure
B) Any paresthesia in limbs or noticeable facial drooping
C) Decrease in urine output with increase in edema in the feet/legs
D) Noticeable change in skin color (yellow), especially around the abdominal area
E) Painless lumps palpated on his neck and cervical spine
Ans: A, B, C
An elevation in systolic BP accompanied by a normotensive diastolic pressure causes a dramatic increase in pulse pressure. Thus, aggressive treatment of systolic hypertension is recommended and has been shown to demonstrate a reduction in stroke, heart failure, kidney disease, and other complications.
5. A geriatrician has ordered an echocardiogram and stress test for an 80-year-old male client in an effort to gauge the clients cardiovascular health status. Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?
A) Increased resting, supine heart rate
B) Low maximal heart rate and cardiac output
C) Increased left ventricular wall thickness
D) Delayed left ventricular filling
In older adults, resting heart rate stays the same or decreases slightly. Answers A, B, and C all capture normal, age-related cardiovascular changes.
6. A nurse provides care for a number of older adult residents of a long-term care facility. Which of the following events from the last shift is most deserving of further assessment and possible interventions?
A) An 83-year-old female client complains of the glare of the fluorescent lights off the floor of the facility.
B) A 79-year-old male client displays unprecedented forgetfulness.
C) A 91-year-old male client who has been newly admitted displays balance problems when ambulating.
D) A 90-year-old long-term resident displays decreased motor strength.
While any abrupt change in status would warrant further examination, decreased strength, light sensitivity, and balance problems are all considered normal accompaniments to the aging process. Cognitive changes, such as a new onset of forgetfulness, are more likely to be pathologic in nature and deserving of further assessment.
7. The educator of a geriatric, subacute medical unit in a hospital is oriented new staff and teaching orientees strategies for communicating with older adults with impaired hearing. Which of the following teaching points is most justifiable?
A) Speak slowly and directly to these clients.
B) Avoid complex or abstract ideas when youre talking.
C) Increase the volume of your speech as much as possible.
D) Choose simple, short words to minimize confusion.
Slow, direct speech is a useful communication technique when dealing with clients who are hard of hearing. It is not necessary to avoid complex ideas or always utilize short, simple vocabulary, since hearing deficits are not synonymous with cognitive deficits. Speaking too loudly is counterproductive.
8. An 81-year-old female is attending a scheduled visit to her family physician. The client asks her doctor why it is that she and her peers seem to get sick frequently, in spite of their efforts to stay active and eat nutritiously. Which of the following responses best captures an aspect of the immune function of older adults?
A) Its normal that the function and resiliency of your immune system decrease with age.
B) Normal, age-related changes combined with outside factors make older adults more susceptible to getting sick.
C) Your body produces fewer antibodies as you age, making you more vulnerable to infections than younger people.
D) With a healthy lifestyle and proper medical treatment, you can generally maintain the same immune function as younger people.
Infections are more prevalent among older adults than younger adults, a situation that results partly from compromised immune function but mostly from the interplay between environmental factors and age-related changes. Illness is not entirely attributable to decreased immune function, and older adults do not necessarily produce fewer antibodies.
9. One of the residents in a long-term care facility has developed numbness, tremor, and gross lack of coordination of muscle movements in his lower limbs. The nurse knows that this may be caused by
A) lack of hydrochloric acid secretion.
B) vitamin B12 deficiency.
C) high intake of calcium products.
D) loss of parietal cells due to gastric ulcerations.
Vitamin B12 deficiency also can cause neurologic abnormalities such as peripheral neuropathy (numbness and tremor), ataxia (loss of coordination of muscle movements), and even dementia. Lack of hydrochloric acid secretions results in impaired gastric absorption. Loss of parietal cells causes a decrease in HCl acid production.
10. As a follow-up to the introduction of a new medication regimen for an older adult client, the physician is interpreting the clients recent blood work, paying particular attention to the clients serum creatinine (Cr) levels (normal range 0.6 to 1.2 mg/100 mL) and glomerular filtration rate or GFR (normal value >60 mL/minute). Which of the following lab results would be considered typical of an older adult with impaired renal function?
A) Cr 1.8; GFR 66
B) Cr 2.3; GFR 30
C) Cr 0.5; GFR 58
D) Cr 1.1; GFR 22
Due to decreased muscle mass and consequent decrease in creatinine production, older adults often maintain normal creatinine levels even in the presence of impaired glomerular filtration and low GFR.
11. A nurse who is visiting a seniors wellness center is teaching a group of older adult women about sexual activity among older adults. Which of the following teaching points best captures the reality of sexual activity among older adults?
A) Androgen replacement therapy for older men can help resolve erectile function and low libido.
B) Cessation of estrogen production after menopause makes sexual activity rarely possible for older women.
C) You can expect the duration and intensity of sexual response to decrease with age.
D) With education, sexual pleasure and frequency can remain similar to that of younger adults.
Though sexual activity by no means ceases among older adults, the duration and intensity do normally decrease. Androgen replacement therapy for men is not yet an established treatment modality. In older women, estrogen production slows but does not cease following menopause. Sexual pleasure and frequency do not normally remain consistent with younger adults.
12. An occupational therapist (OT) is assessing an 80-year-old male client who is poised to return to his assisted living residence following a 14-day hospital stay with a diagnosis of bilateral pneumonia. As part of the OTs functional assessment, the clients activities of daily living (ADL) and instrumental activities of daily living (IADL) are being assessed. Which of the following assessment findings is most indicative of a deficit in ADL?
A) The client is unable to clean the washroom in his residence adequately or safely.
B) The client requires help with dressing himself in the morning.
C) The client is unable to manage his medication regimen without his daughters help.
D) The client requires help climbing the stairs to his residence.
Dressing is considered a core ADL. Cleaning, dressing, and climbing stairs are considered IADL.
13. The son of an 80-year-old man has noticed that in recent weeks his father has become incontinent of urine for the first time in his life. The man is later diagnosed with transient urinary incontinence, a condition that is most often attributable to
A) decrease in bladder and sphincter tone.
B) bladder outlet obstruction.
C) detrusor instability.
Many medications commonly taken by older individuals, including long-acting sedatives, hypnotics, and diuretics, can induce incontinence. Chronic urinary incontinence should not be diagnosed or treated without first undertaking a thorough review of the patients drug regimen. Transient incontinence is less often rooted in physiological changes in the bladder.
14. Recognizing that falls are a significant source of morbidity among older adults, the manager of a geriatric medical unit is conducting a workshop for the health care team on fall prevention. Which of the following patients would the care providers most likely anticipate being at a potentially high risk for falls?
A) A 76-year-old woman with diagnoses of Parkinson disease and orthostatic hypotension
B) A 78-year-old woman admitted for rheumatoid arthritis exacerbation and uncontrolled diabetes mellitus
C) An 81-year-old woman with exacerbation of her chronic obstructive pulmonary disease (COPD) and increasing shortness of breath
D) An 80-year-old man with benign prostatic hyperplasia and consequent urinary retention
Parkinson disease and orthostatic hypotension are both considered common contributors to falls. The health problems cited in answers B, C, and D are not as strongly correlated with falls in older adults.
15. A geriatric clinical nurse educator is teaching the other members of the health care team about the incidence, prevalence, and course of depression among older adults. Which of the following statements is most likely to appear in the physicians teaching?
A) Even though suicide rates are lower among older adults than younger adults, depression needs to be diagnosed and treated early.
B) Though they are certainly not synonymous, depression can be an indicator of dementia.
C) Many older adults lack the symptoms of sleep disturbances and lack of concentration that suggest depression in younger adults.
D) Bronchodilators and antiplatelet medications have been correlated with depression in the elderly.
Depression can be a prodromal symptom of dementia in older adults. Suicide rates in older adults are higher than in younger people. Sleep disturbances and lack of concentration are not noted to be absent in older adults with depression, and bronchodilators and antiplatelet medications are not among the medication linked with the onset of depression.
16. The nurse should anticipate that which type of antidepressant agent may be prescribed for an elderly patient who has a history of numerous cardiac events and who prefers to take medication only once per day?
A) Sertraline, a selective serotonin reuptake inhibitor
B) Nortriptyline, a tricyclic antidepressant
C) Bupropion, an antidepressant
D) Venlafaxine, a serotonin and noradrenaline reuptake inhibitor
SSRIs provide high specificity by blocking or slowing serotonin reuptake without the antagonism of neurotransmitter receptors or direct cardiac effects. Dosing is usually once per day, creating ease of administration. Tricyclic antidepressants have a high suicide rate. The anticholinergic and CV side effects are problematic. SNRIs are similar to SSRI. However, they can be associated with sedation.
17. Which of the following pathophysiological processes would a clinician most likely expect in a client with a diagnosis of dementia rather than delirium?
A) Involvement of cholinergic neurons has caused an accumulation of acetylcholine within synapses.
B) Hypothyroidism has contributed to a decrease in metabolic activity manifesting in neural inefficiency.
C) Dehydration secondary to diuretic overuse has manifested in changes in perception.
D) Plaques have developed between neurons, and neurofibrillary tangles have developed within neurons.
In Alzheimer disease, there are senile plaques that develop between neurons and neurofibrillary tangles that develop within neurons. There is a decline in synaptic levels of acetylcholine rather than accumulation. Dehydration and hypothyroidism would be associated with delirium, not dementia.
18. To help diagnose problems in cognitive function, many nursing facilities utilize the Mini-Mental State Examination (MMSE) tool. Which of the following statements accurately describes this tool?
A) It contains roughly 75 questions that will help identify those individuals at risk for harming themselves.
B) It is a brief, objective tool that will assess memory, orientation, and attention.
C) It is primarily used as a diagnostic tool to help differentiate Alzheimer disease versus dementia.
D) This tool can be utilized to identify worsening of short-term memory.
This tool provides a brief, objective measure of cognitive functioning and has been widely used. It can be administered in 5 to 10 minutes and consists of a variety of questions that cover memory, orientation, attention, and constructional abilities.
19. An elderly patient suspected of having delirium will likely display which of the following clinical manifestations? Select all that apply.
A) Sudden onset of agitation
B) Disorganized thinking pattern
C) Altered level of consciousness
D) Ravenous appetite for sweets
E) Sleeping for long periods
Ans: A, B, C
Delirium has a rapid onset. Key symptoms include agitation, disorientation, and fearfulness along with disorganized thinking and altered level of consciousness.
20. Which of the following factors in an elderly client may increase his risk for an adverse drug reaction? Select all that apply.
A) Intake of numerous over-the-counter medications and vitamins
B) Poor eyesight requiring prescription lens
C) Use of electric openers to open medication bottles
D) Short-term memory loss leading to forgetfulness (as to whether he took the medications)
E) Utilizing pill boxes organized by day of the week
Ans: B, D
Reasons for high rate of errors in administration of medications and compliance include poor manual dexterity; failing eyesight; lack of understanding about the treatment regimen; attitudes and beliefs about medication use; mistrust of HCP; and forgetfulness or confusion.
21. A pharmacist is teaching a group of nurse practitioners about the differences between pharmacokinetics among older adults and among younger clients. Which of the following teaching points best captures an aspect of drug therapy among older adults?
A) Your older patients are going to have higher serum concentrations of water-soluble drugs because of the patients leaner body mass.
B) The absorption time of oral medications is going to be much longer because of decreased gastrointestinal motility in older adults.
C) Plasma concentrations of fat-soluble drugs can increase because older adults have less adipose tissue in which to store excess drug molecules.
D) Decreased renal and hepatic function contributes to accumulation of drugs in these organs.
Lean body mass and lower water volumes result in higher plasma concentrations of water-soluble drugs. Absorption time does not decrease in older adults, and fat-soluble drugs can accumulate in their adipose tissue. Decreased renal and hepatic function results in reduced clearance but not accumulation in the kidneys and liver themselves.
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