257 Exam 4 Questions

An older adult client is having some vision problems. Which one of the following disorders is caused by oxidative damage to the lens?

• Macular degeneration

• Glaucoma

• Cataracts

• Diabetic retinopathy

Answer explanation

Cataracts are a prevalent disorder among older adults and are caused by oxidative damage to the lens protein and fatty deposits in the ocular lens. Age-related macular degeneration is a degenerative eye disease that affects the macula. Although glaucoma’s causes are variable, normally the natural fluids of the eye are blocked by ciliary muscle rigidity, and the buildup of pressure causes damage to the optic nerve. Diabetic retinopathy is a disease of the retinal microvasculature characterized by increased vessel permeability

A client has been complaining of headaches, poor vision in dim lighting, sensitivity to glare, and impaired peripheral vision, and he has a fixed and dilated pupil. He probably has which one of the following disorders?

• Cataracts

• Diabetic retinopathy

• Glaucoma

• Macular degeneration

Answer explanation

Signs of glaucoma can include headaches, poor vision in dim lighting, increased sensitivity to glare, “tired eyes,” impaired peripheral vision, a fixed and dilated pupil, and frequent changes in prescriptions for corrective lenses. Lens opacity reduces visual acuity, halos are seen around objects, vision is blurred, and the perception of light and color is decreased are all symptoms of cataracts. Generally, no symptoms are recognized in the early stages of diabetic retinopathy. Early signs are revealed during eye examinations. Early signs of macular degeneration might include blurred vision, difficulty reading and driving, colors that appear dim or gray, and an awareness of a blurry spot in the middle of vision.

Your client has severe hearing loss, and you are finding it increasingly difficult to talk with him. During your visit, you spend time with him to discuss options to assist him with his hearing. Which of the following would not benefit your client?

• Hearing aids

• Personal listening systems

• Alerting devices

• Talking clocks, large print books, or software that converts text into artificial voice output

Answer explanation

These items would be more beneficial for a person with a vision problem. Hearing aids are a personal amplifying system that includes a microphone, an amplifier, and a loudspeaker. Many aids can be programmed to meet the specific needs of the client. Personal listening systems can be used to enhance face-to-face communication and to better understand speech in large rooms such as theaters. Alerting devices, such as vibrating alarm clocks that shake the bed or activate a flashing light, and sound lamps that respond with lights to sounds might be beneficial

Tags

NGSS.HS-PS4-5

The nurse is providing discharge instructions to a client with glaucoma. Which activities does the nurse instruct the client to avoid? (Select all that apply.)

• Bending over to tie shoes

• Sitting with legs elevated

• Sleeping on more than two pillows

• Blowing the nose frequently

• Lifting objects weighing more than 10 pounds (4.5 kg)

Answer explanation

•Any action that would increase pressure in the eye needs to be avoided, such as bending over, excessive blowing of the nose, and lifting heavy objects that weigh more than 10 pounds (4.5 kg).

•Sitting with the legs elevated or sleeping on more than two pillows is not contraindicated in clients with glaucoma.

Which clients are at high risk for developing hearing problems? (Select all that apply.)

• Airline mechanic

• Client with Down syndrome

• Drummer in a rock band

• Teenager listening to music using ear buds

• Telephone operator

Answer explanation

•Clients who are at high risk for hearing problems include an airline mechanic who is exposed to excessive noise, a client with Down syndrome, (a genetic condition associated with frequent hearing problems), a drummer in a rock band due to exposure to loud noise, and a teenager listening to music using ear buds. Ear buds are known risk factors for increasing potential hearing loss among people who use them on a regular basis with elevated noise levels.

•A telephone operator is not at risk for hearing problems simply because he or she may wear headphones or audio equipment.

You are taking care of a female older adult client with a loss of height and kyphosis. She is also postmenopausal. Which one of the following diagnostic tools would you order?

• Computed tomography (CT) scan of her bones

• Magnetic resonance image (MRI) of her bones

• Bone scan

• Dual-energy x-ray absorptiometry (DEXA) scan

Answer explanation

A DEXA scan is the correct choice of diagnostic tool and is the preferred tool for measuring mineral density in the bones. A CT scan might assist in a diagnosis of osteoporosis; however, this tool would not be the first to be ordered. An MRI might show a loss of density; however, MRIs are more effective for revealing soft tissue issues. A bone scan is usually used to diagnose cancer in the bones, not necessarily for diagnosing osteoporosis

Your client has a history of arthritis. After assessing her condition and finding stiffness with inactivity, pain relieved by rest, and crepitus, you realize she has which one of the following types of arthritis?

• Rheumatic arthritis (RA)

• Gout

• Osteoarthritis (OA)

• Polymyalgia rheumatica (PMR)

Answer explanation

With OA, the joint space narrows; the bones of the joint rub together, which causes pain relieved by rest; swelling develops; and a loss of motion occurs. In classic OA, stiffness with inactivity develops. With activity, OA might lead to pain. In addition, joint instability and crepitus may develop, and a crunching or popping may be felt or heard. OA is usually found in the larger joints. RA is an autoimmune disease and is characterized by pain and swelling in multiple joints in a symmetrical pattern. It generally affects the small joints. Gout causes exquisite pain in the affected joint and wakes up the client in the middle of the night. The joint is bright purple, red, hot, and too painful to touch. PMR may occur at the same time as OA; however, it has a more acute presentation with pain beginning in the neck and upper arms, pelvic area, and possibly in the pectoral girdles. Fatigue and low-grade fever may also occur.

An older adult client has recently been diagnosed with gout. You will need to teach him all of the following EXCEPT

• side effects of medications.

• how to decrease the likelihood of another attack.

• care of the joint.

• reassurance that this is a one-time occurrence.

Answer explanation

After an acute attack, gout may become chronic with periodic acute “attacks.” It is not always a one-time occurrence. The nurse will need to teach the older adult about the side effects (e.g., stomachache, headache, nausea, diarrhea, rash, ulcers) of the gout medication. If the client is prescribed colchicine, watching for diarrhea with blood and a reduced white blood cell count is important. Decreasing the likelihood of another attack will involve a change of diet. Reducing the intake of foods that are high in purine and alcohol and drinking enough fluids daily to help flush the uric acid through the kidneys may decrease the likelihood of another attack. Care of the joint includes elevating the foot, placing nothing on the swollen toe, and taking analgesic agents for the pain and an anti-inflammatory medication for the swelling.

An older adult client who has osteoporosis is discharged from the hospital. What does the nurse include in client teaching related to the client’s home safety?

• Use area rugs on tile floors.

• Keep walkways free of clutter.

• Walk slowly on wet floor areas after mopping.

• Keep light low to prevent glare.

Answer explanation

•The nurse teaches the client that walkways in the home must be clear of clutter and obstacles to help prevent falls.

•Clients with metabolic bone problems should not use area rugs at home because they may cause tripping or falling. Clients with metabolic bone problems must not walk on wet floors because the potential for falling is too great. Keeping the lights low would not allow the client to see adequately to walk safely or avoid an object on the floor.

The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis?

• Consuming one carbonated beverage daily

• Working at a desk and playing the piano for a hobby

• Having a hysterectomy and taking estrogen replacement therapy

• Consuming one alcoholic drink per week

Answer explanation

•Working at a desk and playing the piano for a hobby places the client at risk for osteoporosis. Sedentary lifestyle and prolonged immobility help to produce rapid bone loss.

•The client would have to consume large amounts of carbonated beverages daily (over 40 ounces [1.2 liters]) for this to be a risk factor for osteoporosis. Maintaining estrogen levels reduces the risk for osteoporosis. Alcohol has a direct toxic effect on bone tissue, resulting in decreased bone formation and increased bone resorption. For those who have excessive alcohol intake, alcohol calories decrease hunger and the need to take in adequate quantities of nutrients. However, this client’s alcoholic intake is not high, so it is not a risk factor.