Prepare: The Older Adult

Physiologic Changes in the Older Adult

• A nurse is observing skin integrity of an older adult. Which finding will the nurse document as a normal finding?

Physiologic Changes

• An older-adult client with no acute distress reports being less able to taste and smell. What is the nurse's best response to this information?

Physiologic Changes

• A nurse is teaching a class of older adults about the expected physiologic changes of aging. Which of the following changes should the nurse include in the discussion? Select all that apply.

Self-Check: Assessing Developmental Tasks and Caring

• When assessing the older adult, the nurse should review the client’s achievement of developmental tasks. Which outcome(s) indicates achievement of developmental tasks? Select all that apply.

Caring for the Older Adult

• When caring for the older adult, which information is important to consider?

Self-Check: Ageism

• Ageism is characterized by which of the following?

Self-Check: Risk of Abuse

• When is the risk of abuse of an older adult family member the greatest?

Self-Check: Aging and Physiological Changes

• When assessing an older adult, the nurse knows which of the following is a normal and physiological change related to aging?

Self-Check: Effective Coping

• The nurse provides care for an older adult whose spouse died 8 months ago. Which of the following behaviors indicates that the client is experiencing effective coping? Select all that apply.

Reflect: The Older Adult

Caring for Older Adults

• The nurse works with elderly clients in a community clinic. The client inquires about their mobility and medication recommendations.

Sudden Confusion

• An older adult recently diagnosed with a urinary tract infection displays sudden onset of confusion. What is the client most likely experiencing?

Physiological Change

• Which of the following are normal physiological changes associated with aging? Select all that apply.

Consideration of Aging Changes

• The nurse is providing client teaching for an 85-year-old client who will be going home on anticoagulant therapy. Which strategy reflects considerations of aging changes that may affect this client?

Skin Care and the Older Adult

• Which of the following statements should be included when teaching a group of active older adults about skin care? Select all that apply.

Physical Relationships and the Older Adult

• A healthy 78-year-old woman who is considering marriage to a healthy 79-year-old neighbor tells the nurse that she wonders if they will be able to have sexual intercourse. Which is the nurse's most appropriate response?

Functional Ability

• What is the best resource for identifying information regarding an older adult's current functional ability?

Communication and Hearing Loss

• A nurse in a long-term care facility is caring for several older adults with noticeable hearing losses. Which is the best way for the nurse to communicate with these clients?

Nursing Application for the Older Adult

Prepare: The Older Adult-Nursing Application

Therapeutic Statements

• The nurse is seeing an older adult client in a wellness screening clinic. The client is discussing their current medications, recent shoulder pain, exercising, and taking a daily one-mile walk. Which of the following statements by the nurse is accurate?

Administration of Medications

• A nurse is discussing medication safety with a group of older adults. Which of the following information, when discussed with clients, will increase medication safety? Select all that apply.

Physiologic Changes

• What should the nurse consider when developing the plan of care for an older adult who is hospitalized for an acute illness?

Self-Check: Assessing the Older Adult

• When assessing an older adult, the nurse knows which of the following is a normal and physiological change related to aging?

Self-Check: Delirium

• A 68-year-old client who is hospitalized with pneumonia became disoriented and confused 3 days after admission. Which information indicates that the client is experiencing delirium rather than dementia?

Self-Check: Caregiver Support

• A nurse is caring for an older adult couple in their home. The couple has children and grandchildren, who live far from them and typically visit one to two times a year. The husband is 88 years old and beginning to show signs of Alzheimer’s disease and has mobility issues. The wife is 88 years old and has difficulty managing her diabetes. She is the primary caregiver for her husband and wants to maintain his safety. What support could the nurse provide the wife to care for her husband?

Self-Check: Supporting the Patient

• During a home visit with an 83-year-old client diagnosed with dementia, who is visibly upset and insists that people are throwing away his medals. The nurse observes the daughter telling her father that he is hiding them in the back of the closet and forgetting where he put them. The nurse notices the client becoming increasingly upset and anxious. The nurse offers to role-play a response with the daughter that could help reduce the client’s anxiety. Which statement shared by the nurse would best support the client and his daughter?

Self-Check: Mental Stimulation

Reminiscence

• An 89-year-old client is confused and disoriented. Which of these interventions promotes reminiscence?

Reflect: The Older Adult-Nursing Application

Client Education

• The nurse is planning client education for an older adult being prepared for discharge home after hospitalization with a new cardiac diagnosis. Which nursing action addresses a priority need for this client?

Living with Older Adults

• The nurse is speaking with the daughter of an older adult client about bringing her mother home to live with her family. Which of the following statements, made by the daughter, presents the greatest concern for the nurse?

Cognitive Function

• In reviewing changes in the older adult, the nurse recognizes which of the following statements related to cognitive functioning in the older client as true?

Preventing Falls

• The nurse is providing education on fall prevention with an older adult client recently discharged home. Which of the following statements by the client indicates that more teaching is needed to minimize the risk of falls?

Restorative Care in Long-term Care Setting

• A client has been admitted for restorative care in a long-term care setting following hip replacement. Which of the following interventions promote independence in activities of daily living (ADL)? Select all that apply.

Confused and Agitated

• The nurse is completing a health history with the daughter of a newly admitted client. The daughter reports that the client was diagnosed with Alzheimer's disease 1 year ago. According to the daughter, last night the client became agitated, confused, and was seeing spiders that were not present. The daughter was unable to calm the client and reported that the client did not recognize her. According to this history, what does the nurse suspect the client is experiencing?

Client Medications

• During a home health visit, a nurse talks with a client and their family caregiver about the client’s medications. The client has a history of hypertension and renal disease. Which of the following client findings place the client at risk for an adverse drug event? Select all that apply.

Nursing Intervention

• The nursing student is planning care for an older adult who had a total knee replacement yesterday evening. Which statement by the nurse is the priority to promote skin integrity?

Coping

Prepare: Coping

Stress Management

• During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events?

Denial

• A college student is having difficulty dealing with being dismissed from college due to poor grades. Which statement by the student indicates the defense mechanism of denial?

Intellectualized Defense Mechanism

• The mother of a 38-year-old female recently died due to complications from surgery which required an unexpected colostomy. After her mother's death, the daughter exhibits an intellectualized defense mechanism. Which statement represents this?

Self Check: Conversion Response

• Peter is going through a divorce and trying to juggle work and moving. He is extremely sad and worried about his family. Which of the following behaviors demonstrate that he is experiencing a conversion response? Select all that apply.

Self Check: Stressors

• It’s 15:00 and the nurse is discharging a client who just received a diagnosis of pancreatic cancer. The nurse notices the client appears to have no emotional response and does not ask any questions. Which factor is most likely contributing to the client’s response to this stressor?

Self Check: Problem-Focused Coping

• A 40-year-old client is alarmed at their recent diagnosis of type 2 diabetes. Which of the following actions by the client best indicates a problem-focused coping strategy?

Self Check: Caregiver Burnout

• The nurse is providing support for a caregiver who is feeling burnt out. Which of the following are appropriate suggestions for coping? Select all that apply.

Self Check: Phase of Coping

• The hospice nurse visits a client who is dying of ovarian cancer. During the visit, the client says, "If I can just live long enough to celebrate my daughter's 'sweet 16' birthday party, I'll be ready to die." Which phase of coping is this client experiencing?

Reflect: Coping

First Response

• After a healthcare provider has informed a client that they have colon cancer, the nurse enters the room to find the client gazing out the window in thought. The nurse's first response is which of the following?

Stressful Life Events

• A nurse is assessing a client’s coping after a recent stressful life event. Which of the following questions best assists the nurse in assessing the client’s level of coping?

Assessing Coping

• When a nurse conducts an assessment about how a client is coping, data often comes from which of the following sources? Select all that apply.

Post-Traumatic Stress

• A client who was sexually assaulted a month ago presents to the emergency room. The provider suspects that the client is experiencing post-traumatic stress response. The nurse recognizes which signs and symptoms that best support this?

Developing Care Plans

• A nurse is developing a care plan for a client who is lacking confidence and experiencing stress at home. Which of the following should the nurse do initially?

Initial Assessment

• The nurse is conducting an initial assessment of a client in crisis. When assessing the client perception of the precipitating event that led to the crisis, which is the most appropriate question?

Developmental Stressors

• Which of the following are developmental stressors for clients? Select all that apply.

Nursing Diagnosis

• A client expresses to the nurse that they constantly feel irritated and lose their temper. During the course of the interview, the nurse finds that the client is taking care of their mother who is bedridden following a stroke. The client struggles to balance caring for their family and their mother. Which nursing diagnosis would the nurse most likely identify for this client?

End of Life

Prepare: End of Life

Therapeutic Techniques

• The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply.

Interventions for the Terminally Ill Adolescent

• The nurse is caring for a terminally ill adolescent client. When caring for this client the nurse should implement which intervention?

Palliative Care

• The nurse is caring for a terminally ill child who is receiving palliative care. When explaining the purpose of palliative care to the child's caregiver, the nurse recognizes the need for additional teaching when the caregiver makes which statement?

Self-Check: Palliative Care for Heart Failure

• An 80-year-old client is receiving palliative care for heart failure. What are the primary purposes for receiving palliative care? Select all that apply

Self-Check: Nursing Intervention

• A client has been in the dying process for about 10 days. The client’s spouse has left only for very short periods during this time, and looks pale and exhausted. The nurse, realizing the spouse has not eaten much, suggests that they take a break to eat and rest. The spouse declines, saying, “I don't want to leave. We won't have much more time together and I’m afraid I won’t be here when my love dies.” What is the best action for the nurse?

Self-Check: Witness for a Living Will

• The nurse is caring for a client with cancer. The client tells the nurse that a lawyer will be arriving today to prepare a living will and asks the nurse to act as one of the witnesses for the will. What is the most appropriate nursing action?

Self-Check: Physical Signs of Approaching Death

• The nurse monitors a terminally ill client for which physical signs of approaching death? Select all that apply.

Self-Check: Final Check of Client

• A charge nurse is ready to bring the family in to see their loved one who has recently passed away. They do one final check of the client to ensure the post mortem process has been completed. What would the nurse need to change before the family comes in the room? Select all that apply.

Reflect: End of Life

Client Positioning

• The nurse is caring for a terminally ill client who is experiencing dyspnea. When caring for this client, the nurse should place the client in which position?

Cheyne-Stokes Respirations

• The nurse is caring for a terminally ill client who is experiencing Cheyne-Stokes respirations. Which best describes Cheyne-Stokes respirations?

Do Not Resuscitate (DNR)

• The nurse is caring for a client who has a medical diagnosis of end-stage chronic obstructive pulmonary disease (COPD). The client is in severe respiratory distress and tells the nurse, "Put me on the machine." The client's family says, "No, we are not going to do this again." The client has a do-not-resuscitate (DNR) order. What is the nurse's priority action?

Purpose of Morphine

• A hospice nurse is visiting a client in the client's home. The client has had several episodes of dyspnea, and there is a prescription for morphine elixir. The client's spouse states, "I don't understand why morphine is needed. My spouse is telling me there is no pain. What should the nurse explain for the rationale of administering morphine to this client?

Postmortem Care

• A nurse is supervising the postmortem care of a client. Which action by the unlicensed assistive personnel (UAP) performing the care is appropriate?

Supporting a Spouse

• The spouse of a terminally ill client steps out of the room in tears. The spouse tells the nurse, "I don't know what I'm going to do when my spouse is gone!" What is the nurse's best response?

Care for the Deceased

• Your 54-year-old client with a bowel infection has just died. How should the nurse care for this client?

Religious Practices

• The nurse cares for a dying client who, on admission, shared their religious practices. Based on this information, what should the nurse do to demonstrate sensitivity to the client’s preferred practices?

Nursing Application for Coping

Prepare: Introduction to Nursing Application for Coping

Nursing Stress and Ineffective Coping

• A nurse expresses that they constantly feel stressed and don’t feel like they are handling their workload well. Which of the following behaviors are examples of ineffective coping and increased stress?

Elevated Blood Sugar

• A nurse is caring for a 72-year-old client who is recovering from a stressful and prolonged abdominal surgery. The nurse notes that the client’s blood sugars are elevated. The client has no history of diabetes. To what does the nurse attribute this elevation in blood sugars?

Modeling

• An adolescent client is being seen for their annual healthcare provider visit. The client shares being stressed and unhappy about their progress in losing weight, despite their efforts of increasing exercise. The client’s body mass index (BMI) is 31. Which of the following actions should the nurse perform to incorporate modeling for managing the stress the weight loss is causing the client?

Self-Check: Anticipatory Guidance

• A nurse caring for clients in a hospital setting uses anticipatory guidance to prepare them for painful procedures that the patient is feeling anxious about. Which teaching would the nurse provide?

Self-Check: Coping Mechanisms

• A group of nurses attended a professional development course on coping mechanisms and supporting client needs. Afterwards, they shared the gained knowledge they learned with their peer colleagues. Which of the following statements demonstrates knowledge of coping mechanisms? Select all that apply.

Self-Check: Ineffective Coping

• A nurse is teaching about coping strategies to use at home to family members of a client who is having difficulty coping. Which strategy should be avoided?

Self-Check: Coping with Impending Death

• A nurse is caring for a client in hospice care. The client’s daughter shares that she has accepted that her parent will die soon and wants to know how to help during the last final days. Which of the following are ways that the daughter can cope while caring for her parent. Select all that apply

Self-Check: Stress on the Job

• A staff nurse is telling their nursing supervisor that they are feeling increasingly stressed at work. Which statement by the nursing supervisor is most appropriate?

Reflect: Introduction to Nursing Application for Coping

Coping Success

• The nurse is evaluating the coping success of a client experiencing stress from being newly diagnosed with multiple sclerosis. Which statement by the client demonstrates effective coping?

Stressors for Adolescents

• The nurse is planning care for a 16-year-old client, taking into consideration that stressors experienced most commonly by adolescents include which of the following?

Potential for Effective Coping

• While performing discharge planning for a client recovering from a stroke, the nurse may use which factor as an indication of a client's potential for effective coping?

Positive Coping Strategies

• A new nurse is working in a highly stressful nursing unit and accepting additional shifts. Which strategy will be best for the nurse to use to prevent burnout?

General Adaptation Order

• Place the stages of general adaptation syndrome in the order that they occur.

Stress Types

• Which of the following nursing actions are appropriate for clients experiencing stress? Select all that apply.

Ineffective Coping

• A nurse enters a client’s room and observes the client sobbing. The client states being scared of the upcoming surgery and feeling really stressed. The nurse identifies a nursing diagnosis of "Ineffective coping related to stress of surgery". What is an attainable outcome for this client prior to surgery?