Pearson Custom For Older Adult Nursing Care By Nancy J.Brown And Linda – Test Bank

Chapter 11
Question 1
Type: MCSA
The nurse is aware that the older adult client is more prone to developing infections than the younger adult primarily due to a change in what gland of the aging endocrine system?
1. Thymus
2. Pineal
3. Adrenal
4. Pituitary
Correct Answer: 1
Rationale 1: Correct. The thymus gland is responsible for releasing T-lymphocytes, which control the body’s immune response. It shrinks 90% and does not produce any more T-lymphocytes by age 60.
Rationale 2: The pineal gland produces melatonin, which is involved primarily with sleep, not immune response.
Rationale 3: The adrenal gland produces hormones involved in the body’s stress response, not immune response.
Rationale 4: The pituitary gland produces hormones involved in growth, thyroid functioning and reproductive activities, not immune response.
Global Rationale:

Cognitive Level: Understanding
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging related to the endocrine system.

Question 2
Type: MCSA
An older adult client at a health fair obtains a finger-stick for a capillary blood sugar reading from a nurse. There is a reading of 150 mg/dL, fasting. When advising this client on what steps to take next, the nurse keeps in mind that older adults are predisposed to Type II diabetes mellitus due to what age-related change in the endocrine system?
1. Shrinkage of the thymus gland
2. Insulin resistance of body tissues
3. Decreased pituitary functioning
4. Decreased thyroid hormone secretions
Correct Answer: 2
Rationale 1: The thymus gland is involved with the immune response, not with blood glucose levels. Insulin resistance is the age-related change associated with diabetes mellitus.
Rationale 2: Correct. Insulin resistance as a result of aging predisposes the older adult to development of Type II diabetes mellitus.
Rationale 3: The pancreas, not the pituitary, is involved in insulin production and glucose control in the body. Insulin resistance is the age-related change associated with diabetes mellitus.
Rationale 4: The pancreas, not the thyroid, is involved in insulin production and glucose control in the body. Insulin resistance is the age-related change associated with diabetes mellitus.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging related to the endocrine system.

Question 3
Type: MCSA
What expected change in the older adult’s endocrine system makes it especially important for the nurse to pay attention to an older adult client’s electrolyte lab values when the client is either ill or has had surgery?
1. Delayed release of insulin from the pancreas
2. Secretion of less melatonin by the pineal gland
3. A decrease in production of aldosterone
4. Halting of the production of progesterone
Correct Answer: 3
Rationale 1: Delayed release of insulin from the pancreas predisposes the older adult client to diabetes type II, not to electrolyte imbalances.
Rationale 2: Secretion of less melatonin by the pineal gland affects the older adult’s sleep pattern, not electrolyte imbalances.
Rationale 3: Correct. Because of a decrease in aldosterone, altered regulation of sodium, chloride, and potassium occurs. Hyperkalemia is possible, as well as other electrolyte imbalances.
Rationale 4: The halting of the production of progesterone in older adult females is involved with menopause, not electrolyte imbalances.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Describe the normal changes of aging related to the endocrine system.

Question 4
Type: MCSA
An older adult client has been diagnosed as being pre-diabetic. The client asks for advice from the nurse on how to keep this condition from becoming diabetes. What response by the nurse contains accurate information?
1. “There really is not anything that you can do at this point. If you are already pre-diabetic, then chances are you will become diabetic very soon. You really need to watch your blood sugars very closely.”
2. “You need to go ahead and purchase a glucose monitor and keep track of your blood sugars first thing in the morning and after each meal.”
3. “Basically this condition is caused by the slowing of your basal metabolic rate. If you increase this with exercise, you’ll be able to prevent diabetes.”
4. “There are several changes that you can make in terms of your diet, the amount of exercise and stress in your life, and how much you weigh. Working on these areas can lower your risk for developing diabetes.”
Correct Answer: 4
Rationale 1: It is untrue to say the client can do nothing. There are lifestyle changes that the older adult can make to affect modifiable risk factors (obesity, diet, stress, and exercise) and to lower the chance of developing Type II diabetes mellitus.
Rationale 2: Although it would not be a bad suggestion for the client to keep track of his or her blood sugars, this response does not answer the client’s question concerning preventative measures.
Rationale 3: This statement is not completely accurate. The thyroid gland is responsible for one’s basal metabolic rate, and lack of exercise is a modifiable risk factor for diabetes, but other factors contribute to onset of Type II diabetes mellitus.
Rationale 4: Correct. Lifestyle changes can affect modifiable risk factors (obesity, diet, stress, and exercise) and can lower the chance of developing Type II diabetes mellitus.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the endocrine system.

Question 5
Type: MCMA
The nurse is instructing a group of older adult clients with diabetes in aspects of proper foot care. Which of the following important information should the nurse include in the teaching?
Standard Text: Select all that apply.
1. Assess the feet daily, even the soles.
2. Be sure to let feet air dry after bathing.
3. Apply lotion all over the feet and between the toes.
4. Wash feet with warm, not hot water.
5. Cut toenails straight across after bathing.
Correct Answer: 1,4,5
Rationale 1: Correct. The feet of a diabetic should be assessed daily for any evidence of a break in skin integrity. One should examine the soles of the feet with a mirror.
Rationale 2: One actually needs to dry the feet thoroughly after bathing, even between the toes with a towel, to prevent maceration of the skin.
Rationale 3: Lotion should not be applied to diabetic feet between the toes because it may cause the area to stay moist.
Rationale 4: Correct. Feet should be washed in warm water checked by the wrist or forearm, because the client may have neuropathy and may not notice being burned if the water is too hot.
Rationale 5: Correct. Toenails should be cut when they are still soft, after bathing, and cut straight across to avoid cutting into the cuticle or skin.
Global Rationale:

Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the endocrine system.

Question 6
Type: MCSA
The spouse of an older adult client with diabetes calls the home health nurse and reports that his current capillary blood sugar reading is 68 mg/dL, and that he is still awake, sitting up, and following commands. The spouse asks what should be done. Which reply by the nurse would be accurate?
1. “Give the client 1/2 cup of juice or about 7 hard candies right now. Check the blood sugar level again in 15 minutes and call me back.”
2. “Call 911 right now and have the client transported to the emergency room for administration of IV glucose. I’ll meet you there.”
3. “Don’t do anything. The blood sugar isn’t low enough to treat yet. Just watch the client and give him his medications as ordered.”
4. “Just watch the client. If he becomes unable to eat or drink anything, squirt some frosting into his mouth, and retake his blood sugar level in an hour.”
Correct Answer: 1
Rationale 1: Correct. This statement describes the recommended protocol for caregivers in the home to follow when the blood sugar is low (around or below 70 mg/dL).
Rationale 2: Transport to the ED for administration of IV glucose would only be needed if the client was unconscious.
Rationale 3: Caregivers need to give 1/2 cup of juice or about 7 hard candies to the client whose blood sugar level is low, and they should recheck the glucose level after 15 minutes..
Rationale 4: Watching and waiting is not in the client’s best interest. The hypoglycemia needs to be treated before it gets worse.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts:
Learning Outcome: Discuss methods of health promotion for the endocrine system.

Question 7
Type: MCSA
The nurse educator asks a nursing student to name signs and symptoms of diabetes mellitus in an older adult. Which of the following responses by the nursing student would indicate a good understanding of this topic?
1. “Older adults may show subtle signs and symptoms of diabetes mellitus, such as depression, urinary incontinence, lethargy, chronic pain, or unexplained weight loss.”
2. “Just the three Ps of diabetes: polydipsia, polyuria, and polyphagia. Those are the classic signs and symptoms of diabetes in anyone regardless of age.”
3. “The client would show evidence of weight gain, puffy skin, activity intolerance, and loss of appetite.”
4. “Older adults may show signs and symptoms of anxiety, weight loss, cardiac arrhythmias, and muscle weakness.”
Correct Answer: 1
Rationale 1: Correct. Although the classic signs and symptoms of diabetes are polyuria, polydipsia, and polyphagia, older adults may show subtle signs and symptoms such as depression, urinary incontinence, lethargy, chronic pain, or unexplained weight loss.
Rationale 2: Although the classic signs and symptoms of diabetes are polyuria, polydipsia, and polyphagia, older adults may show subtle signs and symptoms such as depression, urinary incontinence, lethargy, chronic pain, or unexplained weight loss.
Rationale 3: These are signs and symptoms of hypothyroidism, not diabetes mellitus.
Rationale 4: These are signs and symptoms of hyperthyroidism, not diabetes mellitus.
Global Rationale:

Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Discuss conditions and disorders of the endocrine system that are common in older adults.

Question 8
Type: MCSA
An older adult client with a history of psychiatric illness is admitted to the emergency room with the following signs and symptoms: headache, confusion, restlessness, combativeness, and nausea and vomiting. Lab work reveals hyponatremia. The client’s records state that he has been taking haloperidol for years. Based on this information, the emergency room nurse suspects which of the following conditions?
1. HHS (Hyperosmolar Hyperglycemic State)
2. SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)
3. DI (Diabetes Insipidus)
4. Thyroid crisis
Correct Answer: 2
Rationale 1: HHS refers to a metabolic complication of extreme hyperglycemia characterized by blood sugar levels over 600 mg/dL, extreme dehydration, confusion, disorientation, seizures, etc. SIADH is often caused by medications, including older antipsychotics like haloperidol.
Rationale 2: Correct. SIADH is often caused by medications, including older antipsychotics. It is a condition in which antidiuretic hormone (ADH) is secreted even when the body has adequate fluid balance. It can cause fluid overload, and has the following signs and symptoms: hyponatremia, decreased urine output, concentrated urine, weight gain, lethargy, restlessness, combativeness, muscle cramping, anorexia, nausea or vomiting, and a change in level of consciousness (LOC).
Rationale 3: Diabetes insipidus is usually neurogenic, includes decreased production of ADH, and is characterized by polydipsia, dehydration, and associated signs and symptoms.
Rationale 4: Thyroid crisis is a condition that involves an excess of thyroid hormone and associated signs and symptoms. SIADH is often caused by medications, including older antipsychotics like haloperidol.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Discuss conditions and disorders of the endocrine system that are common in older adults

Question 9
Type: MCSA
An older adult female client comes into a walk-in clinic and tells the nurse that she has recently gained weight although her appetite has decreased. She has been having trouble with constipation and an overall lack of energy. The nurse observes the client’s skin to be very dry and flaky and she appears to be losing some hair. Based upon all of the client’s signs and symptoms, the nurse would expect the client to be diagnosed with which of the following endocrine conditions?
1. Thyrotoxicosis
2. Polydipsia dehydration
3. Andropause
4. Hypothyroidism
Correct Answer: 4
Rationale 1: Thyrotoxicosis is an extreme form of hyperthyroidism with signs/symptoms of over-secretion of thyroid hormone. The symptoms here describe hypothyroidism.
Rationale 2: Polydipsia dehydration is actually a sign of diabetes insipidus. The signs/symptoms described in this situation are those of hypothyroidism.
Rationale 3: Andropause actually describes a condition occurring in aging males in which there is a decrease of testosterone produced. These symptoms describe hypothyroidism.
Rationale 4: Correct. Hypothyroidism occurs more frequently in female aging adults and has signs/symptoms of weight gain, decreased appetite, constipation, fatigue, dry skin, alopecia, slowed cognitive functioning, cold intolerance, and puffy skin.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Discuss conditions and disorders of the endocrine system that are common in older adults

Question 10
Type: MCSA
The nurse is assessing an older adult client just admitted to a long-term care facility. The nurse palpates nonpitting edema in the shin area of the client’s legs. The nurse is aware that this type of edema is associated with what type of condition?
1. Cardiac disease
2. Kidney dysfunction
3. Hypothyroidism
4. Venous Insufficiency
Correct Answer: 3
Rationale 1: Edema related to cardiac disease is pitting. Nonpitting edema is associated with endocrine disorders.
Rationale 2: Edema related to kidney dysfunction is pitting. Nonpitting edema is associated with endocrine disorders.
Rationale 3: Correct. Edema associated with an endocrine disorder such as hypothyroidism is nonpitting and usually located in the shins.
Rationale 4: Venous insufficiency leads to a type of edema located in the ankles and feet. Nonpitting edema is associated with endocrine disorders.
Global Rationale:

Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts:
Learning Outcome: Describe the appropriate assessment techniques for the endocrine system.