12-2Test BankCopyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc.Copyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc.Touhy: Ebersole & Hess' Toward Healthy Aging, 8th EditionChapter 12: MobilityTest BankMULTIPLE CHOICEAn older adult patient with a history of osteoporosis is hospitalized for wrist surgery. Which medication that is currently being prescribed would be most likely to interfere with bone integrity?HeparinPremarinCalcitoninTumsANS:ALong-term use of the anticoagulant heparin can cause secondary osteoporosis. Premarin is a form of estrogen, which is used to treat osteoporosis. Although the exact mechanism is not known, calcitonin slows bone resorption and treats osteoporosis-related pain. Tums are calcium.DIF:Cognitive level: ApplicationTOP:Nursing Process: AssessmentMSC:Pharmacological and Parenteral Therapies: Adverse Effects/Contraindications/Side Effects/Interactions/HerbalsWhen answering an older clients questions about diet, exercise, and bone integrity, which exercise would the nurse identify as ineffective at meeting the need for moderately intense aerobic activity?Biking 2 miles dailyJumping rope for 15 minutes dailySwimming laps for 30 minutes twice a weekYoga for 45 minutes twice a weekANS:DModerately intense aerobic results are best achieved through exercise intended to raise heart rate and respiratory rate by such activities as biking, jumping rope and swimming, Yoga is considered excellent as a stretching, flexibility, and balance activity.DIF:Cognitive level: ApplicationTOP:Nursing Process: ImplementationMSC:Health Promotion and MaintenanceIn planning discharge teaching for a client with diabetes, which precaution related to fall prevention is particularly important for the nurse to include?Practicing stress management techniquesRising slowly from the table after mealsRemoving newspapers and other clutter from the floorConsuming recommended daily amounts of vitamin DANS:BAll older persons should be cautioned against sudden rising from sitting or supine positions, particularly after eating. Postprandial hypotension (PPH) occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. PPH is more common in people with diabetes and Parkinsons disease. The remaining options while appropriate are not focused on this particular clients needs.DIF:Cognitive level: ApplicationTOP:Nursing Process: ImplementationMSC:Safe and Effective Care EnvironmentWhich nursing assessment will best identify the older adult individual who is at greatest risk for a muscle weakness related fall?Assessing hand grip strengthAsking the client to stand on one footDetermining if the client taking thyroid medicationAssessing for a history of falls within the last monthANS:CMuscle weakness is often experienced in hyperthyroidism and hypothyroidism. Poor hand grip may not be a result of generalized muscle weakness. The inability to stand erect on one foot may be influenced by neurological causes. A history of falls does not identify the cause of those falls.DIF:Cognitive level: AnalysisTOP:Nursing Process: AssessmentMSC:Health Promotion and MaintenanceWhich client statement indicates an understanding of a primary benefit to be derived from moderately intense aerobic exercise?I will certainly sleep better.Exercise will help keep my heart strong.I can already see a difference in my alertness.When I go to Yoga class I feel more focused.ANS:BAerobic exercise improves and helps maintain cardiovascular functioning while strengthening the heart muscle. While the client may experience the other effects, they are secondary to the primary benefit.DIF:Cognitive level: AnalysisTOP:Nursing Process: EvaluationMSC:Health Promotion and MaintenanceWhen discussing sarcopenia with an older adult, the nurse shares that it:is diagnosed by a positive pannus blood testresults from a deficiency of vitamin Dincludes systemic manifestations as well as bilateral joint deformitiesis responsible for fragility in women more often than in malesANS:DSarcopenia, a condition prevalent in older people and a marker of frailty, contributes to mobility impairments and disability approximately 3 times more often in older women than in men. Rheumatoid arthritis is an inflammatory condition that includes systemic manifestations as well as the characteristic bilateral joint deformity. Pannus, a proliferation of tissue in the synovial space, can be observed on x-ray studies after rheumatoid arthritis has progressed. Osteomalacia is caused by a deficiency of vitamin D.DIF:Cognitive level: ApplicationTOP:Nursing Process: ImplementationMSC:Health Promotion and MaintenanceWhich attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern?keeping several low wattage night lights on in the eveninginstalling wooden railings on the stairway to the bathroomkeeping the side rails up on the clients bed at nightencouraging the client to use a cane when ambulatingANS:CKeeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are appropriate and generally affective.DIF:Cognitive level: ApplicationTOP:Nursing Process: EvaluationMSC:Safe and Effective Care EnvironmentWhen preparing an educational program on the minimizing the effects of aging to a seniors group, the nurses discussion on exercise is based upon the fact that:Aging results in some degree of loss in strength and flexibilityLosses experienced with age related mobility are associated with physical inactivityA positive attitude about aging is a factor in the minimizing of age related changesMobility is affected by aging but the effects can be lessened with lifestyle changesANS:BThe frail health and loss of function we associate with aging is in large part due to physical inactivity. While the remaining options are true statements they are not as related to the positive relationship activity has on mobility.DIF:Cognitive level: ApplicationTOP:Nursing Process: PlanningMSC:Health Promotion and MaintenanceA nurse in the geriatric outpatient clinic frequently receives questions from clients about exercise. The nurse answers their questions based on the knowledge that regular exercise:performed in excess as a young adult will lead to osteoporosisprevents muscle atrophy and improves mobility, thus reducing the risk of fallsmust be avoided by older adults with rheumatoid arthritis because it strains the jointsis likely to lead to increased falls and possibly fracturesANS:BExercise is especially important for older clients. Exercise slows muscle atrophy that occurs with normal aging and promotes flexibility and strength, which improves mobility and decreases the likelihood of falls. Weight-bearing exercises help build bone strength and prevent osteoporosis. It is important that clients with rheumatoid arthritis follow an exercise program to maintain range of motion in joints.DIF:Cognitive level: ApplicationTOP:Nursing Process: ImplementationMSC:Safe and Effective Care EnvironmentWhich principle is the basis for the nurses plan of care regarding exercise for an older adult who is non-ambulatory?Caregivers are usually unaware of the benefits of exercise for these individualsPassive range of motion exercise is best suited for the needs of such a clientNon-ambulatory clients are usually resistant to engaging in any form of exerciseAppropriate exercise will positively affect the individuals quality of lifeANS:DNon-ambulatory older people can also engage in physical activity and may benefit most from an exercise program in terms of function and quality of life. Muscle weakness and atrophy are probably the most functionally relevant and reversible aspects to exercise in non-ambulatory older adults. Passive range of motion is not the best suited exercise unless the client is incapable of any voluntary movement. The remaining options concerning willingness to participate and understanding of importance are not necessarily true nor are they particularly relevant to such care planning.DIF:Cognitive level: ApplicationTOP:Nursing Process: PlanningMSC:Health Promotion and MaintenanceAn 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis Risk for falls. A priority nursing intervention for this client is to:perform a fall assessmentkeep all of the side rails up on the clients bed at nighttimeplace the client on bedrest so that she does not fallassess the clients dietary intake for calcium adequacyANS:ACompleting a fall assessment will enable the nurse to identify and correct the risk factors for this patient. Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury. Maintaining a patient on bedrest can lead to deconditioning and actually contribute to falls. Assessing the clients dietary intake of calcium is a good intervention for this age group, but it is not a priority and will not prevent falls.DIF:Cognitive level: ApplicationTOP:Nursing Process: PlanningMSC:Safe and Effective Care EnvironmentMULTIPLE RESPONSEWhich assessment finding is a contributor to an older clients risk for falls? Select all that apply.client is awaiting cataract surgery on right eyeclients type 2 diabetes is poorly controlled with diet and exercise aloneclient reports a fall in the last yearclient has a history of contact dermatitis and psoriasisclient was adopted at age 5 when parents were killed in a fireANS:A, B, CThe correct options are those that affect the clients vision, presence of factors affecting sensations in the legs and feet, and a history of falls. There is no research to connect the risk of falls with either of the skin conditions mentioned or early emotional childhood traumas.DIF:Cognitive level: ApplicationTOP:Nursing Process: AssessmentMSC:Safe and Effective Care Environment