Comprehensive Nrs 146 Final Exam

Swimming or yoga for 20 minutes 3-5 times a week would best promote health maintenance among older adults when considering normal cardiovascular changes that occur with aging. This is because swimming and yoga are low-impact exercises that can improve cardiovascular fitness, flexibility, and strength without putting excessive strain on the aging body. These activities can help maintain a healthy heart, lungs, and circulation, while also promoting relaxation and reducing stress. Running a marathon once a year, taking 12 hour hikes in the mountains every weekend, or watching sports on television do not provide the same level of regular exercise and may be too strenuous or sedentary for older adults.

Increasing water intake can help soften the stool and prevent constipation. Adequate hydration is essential for maintaining regular bowel movements. Drinking enough water can add bulk to the stool, making it easier to pass. It also helps to keep the digestive system running smoothly. Therefore, advising the client to increase their water intake would be beneficial in relieving constipation.

Elder abuse is most commonly perpetrated by family members of the older adult. This is because family members often have close access and intimate relationships with the elderly, making it easier for them to exploit or mistreat them. Family members may also be under stress or have conflicts with the older adult, leading to abusive behavior. Nursing assistants, nurses, and strangers can also be perpetrators of elder abuse, but statistically, family members are the most common group responsible for such abuse.

Elevating the head of the bed can help maximize existing pulmonary function because it promotes better lung expansion and ventilation. By raising the head of the bed, gravity helps to reduce the pressure on the chest and abdomen, allowing the diaphragm to descend more easily and the lungs to expand fully. This position also helps to prevent aspiration and improve oxygenation, making it easier for the patient to breathe and maximizing their pulmonary function.

Polypharmacy exists when more medicines are used that are clinically necessary. This means that polypharmacy refers to the situation where a person is taking multiple medications, but not all of them are needed for their medical condition. It implies that some medications may be unnecessary or excessive, which can lead to potential harm or adverse drug events. This definition aligns with the concept of polypharmacy as described by the World Health Organization.

Spacing out daily activities can help reduce cardiac workload because it allows for rest periods in between tasks. This prevents the heart from being overworked by continuous physical exertion and stress. By taking breaks and pacing oneself throughout the day, the heart has time to recover and maintain a steady workload, promoting overall cardiovascular health.

When an older patient starts using medications to counteract the side effects of previous medications, it indicates that they have become a victim of polypharmacy. Polypharmacy refers to the use of multiple medications by a patient, often prescribed by different healthcare providers, which can result in adverse drug interactions and increased risk of side effects. Using medications to counteract the side effects of previous medications suggests that the patient is experiencing complications due to the combination of drugs they are taking, indicating a potential case of polypharmacy.

The symptoms described, difficulty starting urine flow and dribbling urine after urination, are indicative of a condition called benign prostatic hypertrophy (BPH). BPH is a non-cancerous enlargement of the prostate gland, commonly seen in older men. As the prostate gland enlarges, it can obstruct the urethra, leading to urinary symptoms such as weak urine flow and post-void dribbling. Stress incontinence refers to the leakage of urine during physical exertion or coughing, which is not described in the scenario. Pyelonephritis is a kidney infection, and nocturia refers to the excessive need to urinate at night, which are not the main symptoms mentioned.

As people age, there is a decrease in cilia, which are tiny hair-like structures in the respiratory tract that help move mucus out of the lungs. This decrease in cilia can lead to a buildup of mucus in the respiratory tract, making it harder to clear the lungs of any infections or irritants. This can increase the risk of complications if a respiratory infection occurs in a 70-year-old individual.

Ageism is the term that describes when someone views older people as different and not having the same desires, needs, and concerns as themselves. Ageism is a form of discrimination and prejudice based on a person's age, particularly towards older adults. It involves stereotyping, stigmatizing, and marginalizing older individuals, often leading to unequal treatment and limited opportunities for them in various aspects of life, such as employment, healthcare, and social interactions. Ageism can have negative impacts on the well-being and quality of life of older people, reinforcing age-related stereotypes and undermining their rights and dignity.

A 17 year old with a developmental disability is not considered to be a vulnerable adult because the term "vulnerable adult" typically refers to individuals who are elderly or have physical or mental impairments that make them more susceptible to abuse, neglect, or exploitation. While the 17 year old may have a developmental disability, they are still considered a minor and are likely to have legal protections and support systems in place to ensure their well-being and safety.

According to Erickson's theory of psychosocial development, older adults go through the stage of ego integrity versus despair. During this stage, they reflect on their lives and may experience a sense of satisfaction or regret. By listening to their stories and recognizing their achievements, nurses can support older adults in finding meaning and purpose in their lives, fostering a sense of ego integrity. This can contribute to their overall well-being and psychological development.

Anosmia refers to the loss or absence of the sense of smell. This means that the client is unable to perceive or detect smells. It does not necessarily imply a decline in taste, as taste and smell are closely related but distinct senses. Therefore, the correct answer is "Absence of smell."

Post menopausal age is a risk factor for osteoporosis because during menopause, a woman's estrogen levels decrease significantly. Estrogen plays a crucial role in maintaining bone density, so the decline in estrogen can lead to a decrease in bone density and an increased risk of osteoporosis. Therefore, being in the postmenopausal age group increases the likelihood of developing osteoporosis.

Decreased gastrointestinal motility can delay the absorption of the oral drug, resulting in a delayed peak effect. This means that the drug takes longer to reach its maximum concentration in the bloodstream, which can affect its therapeutic effectiveness. Taking the antibiotic with milk or not following the prescribed dosage can also affect the drug's absorption and therapeutic range, but in this case, the focus is on the delayed peak effects caused by decreased gastrointestinal motility. Increased cardiac input would not affect the absorption or peak effects of the oral drug.

The correct answer options, "Noise level (silence or using a fan to muffle sounds)," "Dark room (lighting)," and "Temperature of the room (cold or warm)," are all non-pharmacological nursing interventions that can assist an older adult with sleep. Noise level can affect sleep quality, so creating a quiet environment or using a fan to mask other sounds can help. A dark room promotes melatonin production, which aids in sleep. The temperature of the room should be adjusted to the individual's comfort, as extreme temperatures can disrupt sleep. Benadryl is a pharmacological intervention and is not a non-pharmacological nursing intervention for sleep.

Stress incontinence is the most likely type of incontinence in this case. The fact that the client experiences leakage after waking up and coughing suggests that the coughing is putting pressure on the bladder, causing urine to leak out. Stress incontinence is characterized by leakage during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or exercising.

The correct answer is "Decline in taste". Hypogeusia refers to a decrease or decline in the sense of taste. It is a condition where the individual experiences a reduced ability to taste flavors. This can result in a diminished perception of taste sensations, making food and drinks seem less flavorful or bland. It is important to note that hypogeusia is different from the complete absence of taste, as the individual can still detect some taste but at a lower intensity.

Erickson's development crisis for the older adult is Ego Integrity vs. Despair. This stage occurs in late adulthood and involves reflecting on one's life and accepting the choices made. Ego integrity is achieved when individuals feel a sense of satisfaction and fulfillment. Despair, on the other hand, arises when individuals feel regret and a sense of failure. This stage is characterized by the fear of death and the need to find meaning and purpose in life.

In class, we discussed that one of the changes in the cardiovascular and pulmonary systems as a result of primary aging is that valves in veins become less competent. This means that the valves are not able to function as effectively in preventing the backflow of blood, which can lead to conditions such as venous insufficiency or varicose veins.

As a person ages, their musculoskeletal system undergoes certain changes. Ligaments, which connect bones to each other, tend to become stiffer over time. This can lead to reduced flexibility and increased risk of injury. Joint cartilage, which provides cushioning between bones, tends to decrease in quantity and quality, leading to increased friction and potential joint pain. Height also tends to decrease with age due to changes in the spine and bones. However, lung expansion does not increase with age, and in fact, lung function typically decreases as a person gets older.

Presbyopia is a common visual disturbance that occurs as a result of aging. It is characterized by a decline in the ability to focus on nearby objects. This condition is caused by the loss of flexibility in the lens of the eye, making it difficult to bring close objects into clear focus. Therefore, the correct answer is "Decline in their ability to focus on nearby objects."

Flomax (tamsulosin) would most likely be prescribed for an older adult with BPH (Benign prostatic hypertrophy). BPH is a condition where the prostate gland becomes enlarged, causing urinary symptoms. Flomax is an alpha-blocker medication that helps relax the muscles in the prostate and bladder neck, making it easier to urinate. It is commonly used to treat BPH and relieve urinary symptoms such as frequent urination, urgency, and weak urine flow. The other medications listed, Keflex (cephalosporin), Togranil (imipramine), and Detrol (tolterodine), are not typically prescribed for BPH.

After experiencing a transient ischemic attack (TIA), the client is likely to be prescribed Aspirin/ASA (NSAID). Aspirin is commonly used as a preventive treatment for individuals who have had a TIA or are at risk of having a stroke. It helps to reduce the risk of blood clots by inhibiting platelet aggregation. This medication is specifically chosen in this scenario because it is effective in preventing further clot formation and reducing the chances of another TIA or stroke. Methotrexate/Rheumatrex (DMARD) is used to treat rheumatoid arthritis, Ibuprofen (NSAID) is a pain reliever and anti-inflammatory, and Acetaminophen (analgesic) is used for pain relief but does not have anti-inflammatory properties.

The correct answer indicates that the client needs more education about living with and managing Parkinson's disease because it states an incorrect fact. Most people with Parkinson's are actually diagnosed when they are over 50 years old, not under 50 years old. This suggests that the client may have a misunderstanding about the age at which Parkinson's is typically diagnosed, and would benefit from further education on the topic.

Health care providers failing to coordinate medication regimens can be a contributing factor to multiple drug use by older adults. When medications are not properly coordinated, it can lead to the use of multiple drugs that may interact negatively with each other. This can increase the risk of adverse drug reactions and other complications.

Presbycusis is a condition commonly associated with aging, characterized by a gradual decline in hearing ability. This condition is caused by the natural degeneration of the inner ear structures over time, leading to difficulty in perceiving and understanding sounds. Therefore, the correct answer in this case is a decline in hearing.

An older adult with cystitis would most likely be prescribed an antibiotic. Cystitis is an infection of the urinary tract, specifically the bladder, and antibiotics are commonly used to treat bacterial infections. Tricyclic antidepressants are not typically used to treat cystitis, as they are primarily used for depression. Anticholinergics and antispasmodics may be used to help relieve symptoms of cystitis, such as urinary urgency and frequency, but they do not directly treat the infection itself. Therefore, the most appropriate medication for this patient would be an antibiotic.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used for pain management in osteoarthritis. It helps to reduce pain, inflammation, and swelling associated with the condition. Methotrexate is a disease-modifying antirheumatic drug (DMARD) used for rheumatoid arthritis, not osteoarthritis. Clopidogrel is an antiplatelet medication used to prevent blood clots, and aspirin is also an NSAID but is not as effective for osteoarthritis pain as ibuprofen. Therefore, ibuprofen would be the expected medication to be ordered for pain management in osteoarthritis.

In this situation, the most important priority is to ensure the safety and well-being of the vulnerable adult. While reporting the incident and documenting what you saw are necessary steps to take, the immediate action should be to intervene and ensure that the resident is no longer in harm's way. This may involve separating the resident from the family member, alerting other staff members, or contacting security if necessary. Once the resident is safe, you can then proceed with reporting the incident and informing your supervisor.

The BEERS criteria is a tool that provides a list of medications that are considered inappropriate for use by older adults due to their potential risks and side effects. It helps healthcare professionals make informed decisions about prescribing medications to older patients, taking into consideration their unique physiological changes and increased vulnerability to adverse drug reactions. The criteria outline specific medications or drug classes that should be avoided or used with caution in older adults, helping to improve medication safety and reduce the risk of harm in this population.

Ill fitting dentures can contribute to weight loss as they can make it difficult for the client to chew and eat properly. Age-related decrease in saliva production can affect the client's ability to swallow and digest food, leading to weight loss. Limited mobility can restrict the client's access to food, making it harder for them to maintain proper nutrition. However, small diverticuli are unlikely to directly cause weight loss as they are small pouches that form in the lining of the digestive system and are usually asymptomatic.

Given that the client has been diagnosed with Gastroesophageal Reflux Disease (GERD) and is experiencing diminished kidney function, the anticipated type of drug ordered would be a Protein Pump Inhibitor. Protein Pump Inhibitors are commonly prescribed for GERD as they help reduce the production of stomach acid. This can be beneficial for the client as excessive stomach acid can worsen GERD symptoms. Additionally, Protein Pump Inhibitors are considered safe for individuals with diminished kidney function, making them a suitable choice for this client.

If older adults are experiencing sleep disturbances, they may exhibit confusion, decreased memory, and morning headaches. Sleep disturbances can disrupt the normal sleep cycle and prevent older adults from getting sufficient restorative sleep. This can lead to cognitive impairments such as confusion and decreased memory. Additionally, inadequate sleep can cause headaches, particularly in the morning, due to increased tension and lack of proper rest. Therefore, these symptoms can be commonly observed in older adults who are experiencing sleep disturbances.

Bladder training is a technique used to increase the amount of time between urinations and strengthen the bladder muscles. It is most effective in managing urge incontinence, which is characterized by a sudden and strong urge to urinate, often resulting in leakage. This type of incontinence is caused by an overactive bladder, and bladder training can help control and reduce the frequency of these urges, ultimately improving bladder control and reducing leakage episodes. Therefore, bladder training is most helpful in the prevention and management of urge incontinence.

The client with alterations in proprioception but no other significant sensory deficits is at risk for social isolation because they may have difficulty perceiving their own body position and movements, which can affect their ability to interact with others. They are also at risk for falls because proprioception helps in maintaining balance and coordination. However, food poisoning and dehydration are not directly related to alterations in proprioception.

The genital stage of development is the correct answer because it is the stage in Freud's psychosexual theory where individuals experience sexual pleasure through their genitals and develop healthy relationships and friendships. This stage typically occurs during adolescence and adulthood, and it is characterized by the ability to form intimate relationships and express oneself sexually in a mature and healthy way.

In Washington state, advanced directives are known as POLST (Physician Orders for Life-Sustaining Treatment). This form is discussed in class as a means for individuals to communicate their preferences regarding medical treatment, particularly in emergency situations. POLST ensures that healthcare providers are aware of the patient's wishes and can provide appropriate care accordingly.

The correct answer is "The probable number of years a person will live." Life expectancy is a statistical measure that estimates the average number of years a person is expected to live based on various factors such as their age, gender, and health conditions. It is not the maximum length of time a person can possibly live, nor does it refer to targeting someone who is different from yourself.

The correct answer is Iphenhydramine/ Benadryl, Zolpidem/Ambien, and Temazepam/Restoril. These medications are commonly used to assist clients with sleep. Iphenhydramine (commonly known as Benadryl) is an antihistamine that can cause drowsiness and is often used as a sleep aid. Zolpidem (Ambien) is a sedative-hypnotic medication that helps with insomnia by increasing sleep duration and decreasing sleep latency. Temazepam (Restoril) is a benzodiazepine that acts as a sedative and is prescribed for short-term treatment of insomnia. These medications can be effective in promoting sleep for individuals who have difficulty falling asleep or staying asleep.

The question asks for appropriate assessments when assessing an older adult regarding sleep. The correct answer includes asking about key points about the environment during sleep hours, sleep routines including any sleep aides usually utilized, and dietary intake and medication schedules. These assessments are important because they provide information about the sleep environment, habits, and potential factors that may affect sleep quality in older adults. By gathering this information, the nurse can identify any potential issues or interventions that may be necessary to improve sleep in the older adult.

As people age, they may experience a decreased sense of smell, decreased blood supply to the liver, and decreased near-sighted vision. However, age-related changes do not typically affect lactose tolerance. Lactose intolerance is caused by a deficiency of the enzyme lactase, which can occur at any age and is not directly related to normal aging processes.

End Hard?! It's ENDHARM

As individuals age, their sleep patterns tend to change. One common change is that older adults have a longer total sleeping period. This means that they may spend more time in bed asleep compared to when they were younger. Additionally, older adults tend to wake up earlier in the morning. These changes in sleep patterns are a normal part of the aging process.

Sennosides/Senokot is a stimulant laxative
Milk of Magnesia (MOM) is magnesium laxative