Introduction to Gerontology (SZC1)

Correct Answer: A. Decreased cardiac output related to altered contractility and elasticity of cardiac muscle.

Why it’s correct:

The patient’s symptoms of fatigue, ankle swelling, and mild shortness of breath over several weeks suggest heart failure or another cardiac condition, which can lead to decreased cardiac output. Age-related changes, such as reduced cardiac muscle elasticity and contractility, contribute to the heart's diminished ability to pump effectively, causing these symptoms.

Why Other Options are Wrong:

Activity tolerances due to compensation of oxygen supply:

This is not a properly worded nursing diagnosis. While the patient may have decreased activity tolerance due to reduced oxygen supply, this is a consequence of decreased cardiac output, not a primary diagnosis.

Increased cardiac output related to an aging heart muscle:

An aging heart typically experiences decreased cardiac output due to changes such as reduced elasticity, increased stiffness, and possible comorbidities like hypertension or valvular disease. Increased cardiac output is unlikely in this context.

Decreased urinary output due to poor kidney perfusion:

While decreased urinary output may occur as a secondary effect of reduced cardiac output, it is not explicitly described in the patient’s symptoms and would not be the primary nursing diagnosis in this case.

Summary:

The most appropriate nursing diagnosis is Decreased cardiac output related to altered contractility and elasticity of cardiac muscle, as it directly addresses the patient’s symptoms and the likely underlying pathophysiology. Proper evaluation and interventions are needed to manage the patient’s cardiac condition and associated symptoms. 

Correct Answer: A "Did you have the pain before the rash appeared?"

The patient’s symptoms a painful, vesicular rash that burns over the left abdomen are indicative of shingles (herpes zoster). One hallmark of shingles is that pain (often described as burning or stabbing) can occur before the rash appears.

This question helps the nurse assess whether the pain is indeed a precursor to the rash, which is a typical presentation of shingles. 

Why the Other Options Are Incorrect:

"Do you have any food or drug allergies?": While allergies are important to consider in general health assessments, they are not the first priority in this case. The patient’s symptoms point to a specific condition, and this question does not directly help in diagnosing the cause of the rash.

"Have you been around anyone with a rash?": This question is more relevant to the possibility of infectious diseases like chickenpox, but it doesn't directly address the nature of the patient’s current symptoms. Since the rash is vesicular and painful, it’s more likely that the nurse is considering shingles, which is caused by reactivation of the varicella-zoster virus.

"Have your grandchildren visited recently?": Although exposure to children could potentially be relevant if considering chickenpox, shingles is not contagious in the same way. The key concern here is whether the patient has experienced pain before the rash appeared, which would suggest shingles.

Summary:

The most appropriate first question is, "Did you have the pain before the rash appeared?" This helps the nurse assess the likelihood of the patient having shingles, a condition commonly affecting older adults, where pain often precedes the rash. 

Correct Answer: B. The difference between normal and abnormal for the older age group

A nurse assessing the older population must understand what is normal versus abnormal for the older age group. As people age, they experience physical, mental, and emotional changes.

What may be considered normal aging (such as slower mobility or mild memory changes) should be distinguished from abnormal signs, which could indicate underlying health issues, such as dementia, cancer, or cardiovascular disease.

Understanding the differences helps nurses provide appropriate care and identify when further medical evaluation is needed.

Why the Other Options are Wrong:

A. The economic status of the area: 

While it is important to consider the economic status of the community when planning healthcare resources, it is not directly related to a nurse’s immediate clinical assessment of individual patients. The nurse’s primary role is to assess and address the health needs of the patient, not the broader economic context.

C. The signs of sexual dysfunction: 

While nurses should be knowledgeable about sexual health, signs of sexual dysfunction may not be as critical for every patient assessment unless the individual expresses concerns or if there are risk factors that suggest an issue. It is important but not the core focus in all patient assessments for older adults.

D. The signs of cardiac disease: 

While understanding cardiac disease signs is important for older adults, it is a more specific clinical focus. A comprehensive knowledge of normal vs. abnormal aging is broader and more foundational in general nursing practice with the older population, especially since multiple systems and conditions may be at play.

Summary: 

The nurse needs to understand the difference between normal and abnormal in the older population, as aging brings a variety of changes that can vary significantly from person to person. Distinguishing between what is typical aging and what may signal a health issue is crucial for providing effective care and identifying potential health concerns early.

Correct Answer: C Storing the device in a safe, accessible place and ensuring the patient can charge it

The proper storage of the AAC device and ensuring that the patient has easy access to it are critical to supporting the patient’s ability to communicate.

Additionally, it is important to ensure that the device is charged and ready for use when needed. Storing it safely prevents damage and ensures that it remains functional for communication purposes.

Why the Other Options are Wrong:

a) Assuming the device will be used by staff without consulting the patient:

Consulting the patient or caregiver on how to use the device is essential. It ensures that the device is being used correctly and in a way that is comfortable and effective for the patient. Assuming how to use the device without asking is disrespectful and can lead to improper use.

b) Not asking the patient or caregiver for permission before using or handling the device:

Always ask permission from the patient or caregiver before handling their assistive technology. Respect for the patient’s autonomy is crucial, and it ensures that the patient feels comfortable and in control of their communication device.

d) Forgetting to educate the rest of the staff on how to use the device:

All staff and healthcare professionals working with the patient should be educated on how to use the AAC system. This ensures that the patient has consistent support in their communication needs across different care providers and settings.

Summary:

When working with patients who use AAC systems, it is important to be respectful and ensure the device is stored safely and made accessible for the patient. All healthcare professionals involved in the patient’s care should learn how to use the device and assist in charging it as needed, ensuring that the patient’s communication remains uninterrupted. Always ask for permission from the patient or caregiver before handling the device to show respect and maintain the patient's autonomy.

Correct answer: C A loss of strength generated per unit of muscle mass

As individuals age, not only does muscle mass decrease, but there is also a reduction in muscle quality, which refers to the strength generated per unit of muscle mass.

This means that older individuals may have less strength relative to the amount of muscle tissue they have, even if muscle mass remains relatively constant.

Why the other options are wrong:

a) A decrease in muscle size:

While muscle size may decrease with age, the term "muscle quality" specifically refers to the strength per unit of muscle mass, not the size itself.

b) A reduction in the number of muscle fibers:

While muscle fibers may be affected by aging, muscle quality refers to the strength relative to muscle mass, not just the number of fibers.

d) An increase in muscle mass:

This is incorrect. Aging typically leads to a decrease in muscle mass, not an increase, and muscle quality is linked to strength relative to mass, not the increase in mass.

Summary:

The loss of muscle quality with age refers to the decline in strength generated per unit of muscle mass. Therefore, the correct answer is c) A loss of strength generated per unit of muscle mass.

Correct Answer: D. Grooming

Grooming is an essential activity of daily living (ADL) because it involves personal hygiene and self-care tasks like brushing teeth, combing hair, and shaving. These activities are fundamental for maintaining personal cleanliness and a sense of well-being. Being able to perform grooming tasks independently is key to living autonomously and maintaining dignity in daily life.

Why the Other Options Are Incorrect:

a) Baking: While baking may be an enjoyable or important task for some people, it is not considered an essential ADL. ADLs focus on basic self-care and functional activities necessary for survival and independence, such as eating, dressing, bathing, and grooming.

b) Shopping: Shopping is an instrumental activity of daily living (IADL), which supports independent living but is not as fundamental as the basic ADLs (e.g., grooming, bathing, dressing). While important, shopping is not essential for day-to-day survival.

c) Driving: Driving is also an IADL, as it is an important function for maintaining independence in transportation but is not required for personal survival. Many individuals live independently without driving, using alternative transportation options.

Summary:

Grooming is a key ADL that supports self-care and independence, making it the correct answer in this context.  

Correct Answer: B. Checking the patient’s tone of voice and ability to speak.

After a thyroidectomy, there is a risk of vocal cord spasm or edema due to trauma or irritation of the recurrent laryngeal nerve or surrounding structures.

By assessing the patient’s tone of voice and ability to speak, the nurse can identify hoarseness, changes in pitch, or difficulty speaking, which are indicative of vocal cord dysfunction.

Why the Other Options are Wrong:

Auscultating the patient’s neck over the vocal cords:

Auscultation is not a reliable method to detect spasm or edema of the vocal cords. It would not provide the necessary information to assess vocal cord function

Monitoring the patient for dysphagia:

While dysphagia (difficulty swallowing) can occur with damage to nearby structures during thyroidectomy, it is not the primary sign of vocal cord spasm or edema. This symptom may be related to esophageal or pharyngeal issues instead

Observing the patient for changes in mental status:

Changes in mental status are not directly related to vocal cord spasm or edema. They might indicate other complications, such as hypocalcemia from parathyroid gland involvement, but they are not relevant to vocal cord assessment.

Summary:

The most effective method to assess for vocal cord spasm or edema in a patient post-thyroidectomy is to check the tone of voice and ability to speak. Changes in voice, such as hoarseness or difficulty speaking, are key indicators of potential vocal cord dysfunction, making this the most appropriate nursing action. 

Correct Answer: B. Exercise.

Explanation:

For a 76-year-old patient with osteoarthritis (OA) who is experiencing pain, stiffness, and deformities in the fingers, exercise is an important recommendation.

Exercise helps to improve joint function, reduce stiffness, and strengthen muscles around the joints, which can alleviate pain.

Low-impact exercises, such as stretching, strengthening exercises, and range-of-motion exercises, are often recommended for OA patients.

Why Other Options are Wrong:

Cold packs:

Cold therapy may be helpful for acute flare-ups of pain or inflammation but is typically more useful for reducing swelling and providing short-term relief. Chronic osteoarthritis symptoms are generally better managed with exercise.

Meditation therapy:

While meditation can help with stress management and pain relief, it is not a primary intervention for osteoarthritis symptoms. However, it could be used as a complementary approach to managing chronic pain.

Vitamin therapy:

There is limited evidence to support the idea that vitamin supplements (such as vitamin D or glucosamine) alone will alleviate osteoarthritis symptoms significantly. Although some vitamins and supplements may help in some cases, exercise remains a core therapeutic recommendation for OA management.

Summary

Therefore, exercise is the most effective and evidence-based recommendation to help manage the pain, stiffness, and deformities associated with osteoarthritis in this patient.

Correct Answer: A. Intermittent claudication.

Intermittent claudication is the hallmark symptom of peripheral artery disease (PAD). It refers to cramping or pain in the muscles (typically in the calves) that occurs during physical activity, such as walking, and is relieved by rest.

This occurs due to reduced blood flow to the muscles as a result of arterial narrowing or blockages.

Why Other Options are Wrong:

Warm extremities:

In PAD, affected extremities are often cool to the touch due to reduced arterial blood flow. Warm extremities are not a characteristic feature of PAD.

Pain unrelieved by rest:

Pain unrelieved by rest suggests critical limb ischemia, a severe and advanced stage of PAD. However, it is not the most common symptom. Early stages of PAD are typically characterized by intermittent claudication.

Bounding pulse:

PAD typically leads to diminished or absent pulses in the affected extremities due to reduced blood flow. Bounding pulses are more associated with hyperdynamic circulation or conditions like aortic insufficiency.

Summary:

The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which presents as pain or cramping in the legs during activity and resolves with rest. Other symptoms, such as diminished pulses or cold extremities, may also be present, but intermittent claudication is the hallmark early sign.