Nursing Care of Older Adult Patients

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is monitoring a patient’s skin status. What should the nurse recognize as the first sign of prolonged pressure on the skin?
a. Coolness
b. Cyanosis
c. Paleness
d. Redness
____ 2. The nurse has been providing interventions to address an older patient’s nutritional status. Which observation should the nurse use to determine if nursing care has been effective?
a. Appetite
b. Skin turgor
c. Body weight
d. Urine output
____ 3. The nurse is concerned about medication safety for a patient with confusion. Which action should the nurse recommend be included in the patient’s plan of care to address this issue?
a. Instruct the patient to take all of the medications together.
b. Have the patient set up the medications for an entire week.
c. Have a family member set up and administer the medications.
d. Have the patient turn medication bottles upside down after taking medication.
____ 4. The nurse is caring for a patient with Alzheimer’s disease. Which environment should the nurse provide to decrease the patient’s symptoms?
a. A variety of sensory experiences
b. An environment that varies weekly
c. A physically challenging environment
d. A familiar, non-stimulating environment
____ 5. The nurse is collecting data for an older patient. Which characteristic should the nurse identify in a patient with an age-related loss of water in the vertebral discs?
a. Spinal flexion
b. Decreased height
c. Increased spinal flexibility
d. Protruding bony prominences
____ 6. The nurse has reinforced teaching about age-related mouth changes. Which client statement indicates a correct understanding of the cause of tooth loss in an older adult?
a. “Jawbone loss.”
b. “Receding gums.”
c. “Poor dental care.”
d. “The aging process.”
____ 7. The nurse is making recommendations to an older patient’s plan of care for safety measures. Which musculoskeletal change should the nurse consider as contributing to a reduction in the older adult’s ability to safely perform routine tasks?
a. Increased reflexes
b. Increased joint flexibility
c. Rapid nerve transmissions
d. Slower muscle response time
____ 8. The nurse is reinforcing teaching provided to an older patient on how to safely rise from a seated to a standing position. Which age-related change does the nurse use to emphasize the need to change positions gradually for safety?
a. Joint stiffness
b. Leg muscle weakness
c. Decreased circulatory efficiency
d. Decreased neurological reflex times
____ 9. The nurse is providing care to a person who has difficulty hearing high-pitched tones. Which action should the nurse take when caring for this patient?
a. Speak loudly from across the room.
b. Speak softly, using a near-whisper tone.
c. Speak slowly, emphasizing lip movements.
d. Speak rapidly, using multiple hand gestures.
____ 10. A 70-year-old patient asks what can be done to protect his hearing. What should the nurse recommend to the patient?
a. Clean the ears of ear wax every day.
b. Cover the ears if loud noises are expected.
c. Have a hearing test performed twice a year.
d. Raise the volume on televisions and radios in the home.
____ 11. The nurse is making a home health visit to a frail but basically healthy 86-year-old patient. The nurse assesses a heart rate of 104 beats/minute. What action should the nurse take?
a. Inform the physician of the heart rate immediately.
b. Teach the patient deep breathing exercises to reduce heart rate.
c. Ask about liquids the patient is drinking and urination frequency.
d. Have the patient request a tranquilizer from the physician at the next visit.
____ 12. The nurse is contributing to a patient’s plan of care for comfort needs. What age-related change would explain why an 84-year-old patient is chronically cold even with the thermostat set at 80°F (26.6°C)?
a. Decreased subcutaneous fat layer
b. Increased layer of subcutaneous fat
c. Increased muscular retention of heat
d. Decreased muscular retention of heat
____ 13. The nurse is making recommendations to the plan of care for a patient who has limited mobility. On which skin condition should the nurse focus as the greatest risk for this patient?
a. Rashes
b. Melanoma
c. Pressure ulcer
d. Venous stasis ulcer
____ 14. The nurse is collecting patient data. Which findings should the nurse expect because of a decrease in melanin?
a. Graying of hair
b. Thinning of hair
c. Thinning of bone
d. Thickening of bone
____ 15. The home health nurse is visiting an older patient who fears becoming incontinent and reports restricting personal fluid intake to prevent urinary leakage. Which action should the nurse take?
a. Instruct the patient to drink more fluids.
b. Praise the patient for this creative action.
c. Refer the patient to a continence program.
d. Provide the patient with literature on oral fluids.
____ 16. The home health nurse is visiting an older adult who reports nocturia. Which night-light bulb color should the nurse suggest to increase safety and enable the patient to see better at night?
a. Red
b. White
c. Yellow
d. Orange
____ 17. The nurse is reinforcing teaching with an older patient. When interacting with the patient the nurse should recognize which effect of aging on short- and long-term memory?
a. Both types of memory are retrieved more easily with aging.
b. Short-term memory is slightly more difficult to retrieve with aging.
c. Short-term memory is retrieved more easily than long-term memory.
d. Long-term memory is retrieved more easily than short-term memory.
____ 18. The nurse is caring for a patient who is prone to developing constipation. Which action should the nurse take to help this patient?
a. Give the patient a Fleet enema.
b. Help the patient develop an exercise routine.
c. Instruct the patient to use suppositories once a week.
d. Instruct the patient to take an oral laxative every night.
____ 19. Which measure should the nurse recommend for inclusion in the plan of care for an older adult who has a nursing diagnosis of ineffective sexual patterns?
a. Play favorite music.
b. Schedule private time.
c. Provide a soft mattress.
d. Provide pain medication.
____ 20. While assisting with the admission of a new resident to the long-term care facility, the nurse notes the patient’s feet are moist with dry skin on the heels. The toenails are long and brittle. Which action should the nurse take first?
a. File the nails.
b. Dry feet well.
c. Apply lotion to the feet.
d. Soak feet in warm water.
____ 21. The nurse is administering medications to a group of older residents and monitors them for adverse reactions. In which way should the nurse recognize that a reduction in liver enzyme production effects medication metabolism in the older patient?
a. The elimination of substances is increased.
b. The metabolism of substances is decreased.
c. There is increased detoxification of substances.
d. There is a need for an increase in the medication dosage.
____ 22. The nurse is identifying recommendations to help an older patient with sleeping needs. What should the nurse recognize as a sleeping pattern in the older adult?
a. Sleep needs decrease.
b. Rest time is decreased.
c. Rest patterns are unchanged.
d. Sleep needs remain unchanged.
____ 23. The nurse is reviewing the ages of assigned patients in a skilled nursing facility. Which patient age represents the fastest–growing segment of individuals in the United States?
a. 64
b. 70
c. 81
d. 87
____ 24. The nurse is evaluating the skin of an older patient who has been lying in bed for most of the day. How long would it take a pressure ulcer to begin to form in this patient?
a. 5 minutes
b. 10 minutes
c. 15 minutes
d. 20 minutes
____ 25. The nurse has finished drawing blood from an older patient. How long should the nurse apply pressure to the puncture site?
a. 2 minutes
b. 3 minutes
c. 4 minutes
d. 5 minutes
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 26. The nurse is contributing to the care plan of an immobile patient. What should the nurse recognize as increasing the patient’s risk of developing a pressure ulcer on the heels? (Select all that apply.)
a. Being obese
b. Turning every hour
c. Lying on wet linens
d. Impaired circulation
e. Elevating legs on pillows
f. Wearing oxygen at 2 L per nasal cannula
____ 27. The nurse is contributing to a staff education program about the physical changes of aging. What should the nurse include as a common change in the skeletal system of an older adult? (Select all that apply.)
a. Osteoporosis
b. Eroded cartilage
c. Thickening of bone
d. Increased flexibility
e. Shortening in height
f. Increasing bone density
____ 28. The nurse is collecting data for a patient who has a developing pressure ulcer. What should the nurse expect to assess as early manifestations of a pressure ulcer? (Select all that apply.)
a. Coolness of site to touch
b. Cyanosis of site observed
c. Report of redness at the site
d. Report of burning at the site
e. Tenderness at site when touched
f. Report of decreased sensation at site
____ 29. The nurse is contributing to a staff education program on grooming techniques for older adults. Which methods should the nurse recommend to reduce the potential for nail infections? (Select all that apply.)
a. Cut nails with scissors.
b. Clip nails with nail clippers.
c. File nails with an emery board.
d. Use resident’s own grooming equipment.
____ 30. An older patient with diabetes mellitus reports difficulty sleeping. Which manifestations should the nurse recognize as being related to sleep deprivation? (Select all that apply.)
a. Fatigue
b. Anxiety
c. Irritability
d. Hyperactivity
e. Persistent hunger
f. Decreased pain sensitivity
____ 31. The nurse is contributing to the plan of care for an older adult. Which should the nurse recognize as being age-related changes of the integumentary system? (Select all that apply.)
a. Thinning of the scalp hair
b. Increase in nail growth rate
c. Decreased sweat production
d. Increased dryness of the skin
e. Increased subcutaneous fat layer of skin
f. Increased growth of nose, ear, and facial hair
____ 32. The nurse is contributing to the plan of care for an older adult. What should the nurse recognize as being age-related changes in the cardiovascular system? (Select all that apply.)
a. Less efficient leg veins
b. An increase in heart rate
c. Decreased cardiac output
d. Decreased blood pressure
e. An increase in irregular heartbeats
f. Thinning of the heart valves and aorta
____ 33. The nurse is contributing to a staff education program to prevent falls in the older population. What should the nurse include as areas to assess for fall prevention? (Select all that apply.)
a. Use of alcohol
b. History of falls
c. Medication side effects
d. Pressure sore development
e. Gait and balance screening
____ 34. The nurse is identifying ways to ensure environmental safety for an older patient. Which actions should the nurse recommend for this patient’s plan of care? (Select all that apply.)
a. Place call light within reach.
b. Demonstrate confidence during care.
c. Ask for permission before moving items.
d. Return items to patient preferred location.
e. Plan ahead and communicate plans to patient.
____ 35. During a visit to the wellness clinic, an older patient with arthritis asks what can be done to improve joint motion. What should the nurse suggest to this patient? (Select all that apply.)
a. Walk with an assistive device as needed.
b. Wear non-skid sturdy shoes when walking.
c. Perform range-of-motion exercises in warm water.
d. Consume a balanced diet rich in vitamin D and calcium.
e. Take prescribed anti-inflammatory medications before exercising.
____ 36. The nurse is assisting in the preparation of a teaching session for older patients on respiratory health. What information should the nurse suggest be included in this program? (Select all that apply.)
a. Instruct regarding the importance of frequent position changes to stimulate all lung lobes
b. Recommend deep breathing and coughing as part of a daily exercise program
c. Encourage receiving pneumonia vaccination and annual influenza vaccination
d. Suggest taking an over-the-counter expectorant every day to help remove lung secretions
e. Remind that life-long habits and exposure to respiratory irritants may influence breathing
____ 37. The nurse is concerned that an older patient is demonstrating signs of depression. What did the nurse observe to come to this conclusion? (Select all that apply.)
a. Difficulty sleeping
b. Change in behavior
c. Reminiscing about past events
d. Increase in physical complaints
e. Inability to recall events from a week ago
____ 38. During a home visit, the nurse suspects that an older patient recovering from an acute illness is not taking medications as prescribed. What should the nurse assess to determine the patient’s adherence to prescribed medications? (Select all that apply.)
a. Use of over-the-counter or herbal remedies
b. Pharmacy that filled the patient’s prescriptions
c. Location of the medications in the patient’s home
d. Frequency with which medication doses are being skipped
e. Frequency with which medications are being taken as prescribed

Chapter 15. Nursing Care of Older Adult Patients
Answer Section

MULTIPLE CHOICE

1. ANS: D
D. Early signs of pressure ulcer formation are warmth, redness, tenderness, and a burning sensation at the potential ulcer site. A. B. C. Coolness, cyanosis, and paleness indicate a lack of blood flow to an area.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

2. ANS: C
C. The single most important clinical measure of under-nutrition in older adults is current body weight and recent changes. The patient’s body weight should be used to determine if interventions have been effective. A. Appetite will not help determine if interventions regarding nutritional status have been effective. B. D. Skin turgor and urine output are helpful in determining fluid balance.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

3. ANS: C
C. As the patient is confused, having a family member assist with the medications is the best option. Interventions that rely on the patient’s memory (A, D) are not helpful. B. The patient could become more confused if expected to turn medication bottles upside down after use.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

4. ANS: D
D. With dementia, an atmosphere that provides for physical and emotional safety with consistency and calmness should be provided. A. Sensory overload should be decreased for confused patients. B. Varying the environment weekly would provide too much stimulation for the patient. C. Physically challenging environments would be too stimulating for the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

5. ANS: B
B. Shorter height is caused by water loss in the intervertebral disks of the spinal column. A. Spinal flexion is a result of gravity over time. C. Older patients most likely will not demonstrate increased spinal flexibility. D. Protruding bony prominences are not related to a loss of water in the vertebral discs.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

6. ANS: C
C. Tooth loss is not a normal change of aging. With proper lifelong dental care, teeth should last a lifetime. A. B. D. Tooth loss in an older adult is not because of bone loss in the jaw, receding gums, or the aging process.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Analysis

7. ANS: D
D. With aging, muscle response slows, so more time is required to perform tasks. This leads to increased reaction times. A. B. D. The aging process does not cause an increase in reflexes, joint flexibility, or nerve transmission.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Analysis

8. ANS: C
C. Changes in body positioning from lying to sitting to standing need to occur gradually to accommodate the less efficient circulatory systems of older patients. A. B. D. The need for an older patient to change positions slowly is not related to joint stiffness, muscle weakness, or neurological reflex times.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

9. ANS: B
B. For older patients, the first difficult sounds to discriminate are high-pitched tones. It is often more effective to whisper when communicating with the hearing-impaired individual, because whispering decreases the pitch of the sounds. A. C. D. Speaking loudly, emphasizing lip movements, or speaking rapidly with hand gestures is not going to enhance communication with this patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

10. ANS: B
B. It is important to use hearing protection throughout life, because noise damage to the ear is usually not reversible. The patient should be encouraged to cover the ears if loud noises are expected. A. Cleaning the ears of earwax everyday could lead to an ear infection. C. Hearing tests do not need to be performed twice a year. D. Raising the volume on televisions and radios could potentiate hearing loss.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

11. ANS: C
C. One of the first signs of dehydration is tachycardia. A. Further data are needed to report to the physician. B. Deep breathing exercises may not affect the heart rate. D. The client does not need a tranquilizer for this heart rate.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

12. ANS: A
A. An aging-related change in the integumentary system is decreased subcutaneous fat layer of skin, so older patients have less insulation to maintain temperature. B. Older patients do not have an increased layer of subcutaneous fat. C. D. The feeling of cold is not related to muscle function.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Analysis

13. ANS: C
C. The older patient with limited mobility is especially prone to developing pressure ulcers. B. Rashes could affect individuals of all ages. B. The older patient is not particularly prone to developing melanoma. D. Venous stasis ulcers can occur in individuals of all ages.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

14. ANS: A
A. Decreased melanin results in gray hair. B. Decreased melanin does not impact the volume of hair. C. D. Melanin does not impact the density of bone.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

15. ANS: D
D. Older patients may try to inappropriately decrease the chance for leakage by severely limiting fluid intake. This approach often results in dehydration. Because fluid intake needs to be encouraged in older patients, focus educational efforts on topics such as liquid intake timing and beverage selection. A. The patient needs more information than simple instruction to drink more fluids. B. Restricting fluids is not a creative action. C. The patient does not need a continence program at this time.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

16. ANS: A
A. Night vision can be enhanced with the use of a red night-light, because red lighting is more easily detected by the cones and rods in the older patient’s eye. B. C. D. White, yellow, or orange light bulbs in night-lights will not help the older patient improve night vision.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

17. ANS: D
D. Long-term memory retrieval is easier in old age than short-term memory retrieval. A. Both types of memory are not retrieved easily with aging. B. C. Assist the patient having short-term memory problems by using written lists, visual cues, and other memory-enhancing systems to strengthen short-term memory skills.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Analysis

18. ANS: B
B. Educate the older patient about the important relationship between intake of fiber and water and exercise in the promotion of effective bowel evacuation. A. C. D. Enemas, suppositories, and medications are considered only after dietary management is found to be ineffective.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

19. ANS: B
B. Sexuality is one of the basic physiological needs identified in Maslow’s hierarchy for all individuals regardless of age. Privacy is a common problem in health care settings, so provide scheduled private time for sexual expression. A. C. D. Playing music and providing a soft mattress and pain medication may or may not be appropriate or desired to meet the older patient’s sexual needs.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

20. ANS: D
D. Nails in an older individual are often hard and brittle. Soaking in warm water helps soften nails to ease in their trimming. A. Filing the nails can be done once the nails are softened. B. Drying the feet would be appropriate after soaking them. C. Lotion can be applied after foot care has been completed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

21. ANS: B
B. A reduction in liver enzymes causes a reduction in drug metabolism and detoxification. A, C, and D would all be decreased in the older patient because of a reduction in liver enzyme production.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Analysis

22. ANS: D
D. The need for sleep in elderly patients does not decrease with age, but the sleep and rest pattern usually varies from earlier times.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Analysis

23. ANS: D
D. The fastest growing segment of people over the age of 65 is those who are ages 85–94.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

24. ANS: D
D. Ischemia from unrelieved pressure can begin to develop in 20 to 40 minutes. A. B. C. It takes longer then 5, 10, or 15 minutes for a pressure ulcer to begin to develop.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

25. ANS: A
A. When drawing blood from an older patient, hold light pressure at the injection site for at least 2 minutes after the needle is removed. B. C. D. Holding pressure to the site for longer than 2 minutes can cause bruising.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

26. ANS: C, D
C. D. Pressure ulcers are caused by ischemia, which results from continuous pressure that reduces blood flow to the area. Those with impaired circulation are at greater risk of developing a pressure ulcer. Linens should be kept clean, dry, and wrinkle-free. A. Obesity does not necessarily increase the client’s risk for developing a pressure ulcer on the heels. B. E. F. Turning every hour, elevating the legs on pillows, and using oxygen would not contribute to the development of pressure ulcers.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

27. ANS: A, B, E
A. B. E. Some key age-related changes in the skeletal system include osteoporosis, eroding cartilage, and shortening of height. C. D. F. Age-related changes in bone structure include exaggerated bony prominences. Flexibility decreases with aging. Bone density decreases with aging.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

28. ANS: C, D, E
C. D. E. Early signs of pressure ulcer formation are warmth, redness, tenderness, and a burning sensation at the potential ulcer site. A. B. F. Early manifestations of pressure ulcer formation do not include coolness, cyanosis, or decreased sensation at the site.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

29. ANS: C, D
C. D. Filing the nails with an emery board is safer than cutting the nails. Avoid sharing grooming equipment to prevent the spread of infection. A. B. Cutting or clipping the nails could cause an injury. E. Providing nail care in the patient shower could be unsafe depending upon the patient’s condition.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

30. ANS: A, C
A. C. Lack of sleep leads to fatigue, irritability, increased sensitivity to pain, and increased likelihood of accidents. B. D. E. F. Anxiety, hyperactivity, persistent hunger, and decreased pain sensitivity are not manifestations associated with sleep deprivation.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Analysis

31. ANS: A, C, D, F
A. C. D. F. Key changes in the integumentary system with aging include thinning of scalp hair, decreased sweat production, increased dryness of the skin, and increased growth of nose, ear, and facial hair. B. Nail growth rate decreases with aging. E. Subcutaneous fat tissue decreases with aging.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

32. ANS: A, C, E
A. C. E. Changes in the cardiovascular system with aging include less efficient leg veins, decreased cardiac output, and an increase in irregular heartbeats. B. Heart rate does not increase with aging. D. Blood pressure increases with aging. F. Heart valves and aorta thicken with aging.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

33. ANS: A, B, C, E
A. B. C. E. Assessment may include the use of alcohol, a history of falls, and review for medications that may cause dizziness, weakness or sleepiness as well as gait and balance screening. D. Pressure sore development is not assessed for fall prevention in the older patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

34. ANS: A, C, D
A. C. D. Nursing actions to ensure for environmental safety include placing the call light within reach, asking for permission before moving items, and returning items to the patient preferred location. B. E. Demonstrating confidence during care and planning ahead and communicating plans to the patient are interventions to support deliberate actions.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

35. ANS: C, E
C. E. Performing range-of motion-exercises in warm water helps the patient for whom movement is uncomfortable. If the person has arthritis, the administration of any prescribed anti-inflammatory medications should be timed so their action peaks when the exercises begin. A. B. Walking with an assistive device and wearing non-skid shoes reduces the risk of falls. D. Consuming a balanced diet rich in vitamin D and calcium supports bone health.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

36. ANS: A, B, C, E
A. B. C. E. Because of the normal changes that take place in the respiratory system with aging, it is important to instruct older patients to change positions frequently, participate in deep breathing and coughing exercises, receive the pneumonia and annual influenza vaccinations; remind patients of the impact that lifelong habits have on respiratory health. D. Taking an over-the-counter expectorant every day is not recommended to maintain respiratory health in the older patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

37. ANS: A, B, D
A. B. D. Depression is the most common psychiatric problem among older adults. This psychological condition, which includes a disturbance in mood, increases the risk for physical health complaints, and sleep disturbances. C. Reminiscing about past events is not a manifestation of depression. E. The inability to recall events from a week ago indicates a change in short-term memory.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Analysis

38. ANS: A, D, E
A. D. E. Older patients may use different treatments for ailments. Over-the-counter medications or herbal remedies may be substituted for prescribed medications. Older patients also may skip doses to save money. The nurse needs to assess the frequency with which medications are being taken as prescribed, the number of doses missed, and if other remedies are being used in place of prescribed medications. B. C. The pharmacy that filled the prescriptions and the location of the medications in the patient’s home would not contribute to the patient’s non-adherence to the prescribed medication regimen.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application