Test Bank For Porth’s Pathophysiology, Concepts of Altered Health States- 9th Edition by Sheila Grossman-Carol Mattson Porth

1.

Of the following aging theory examples, which one supports the nonstochastic beliefs about aging?

A)

Mitochondrial DNA damage has accumulated to such a level that the person has physiological symptoms of declining health.

B)

Oxidative free radicals result in by-products that react with DNA to lead to cellular damage.

C)

The wear-and-tear theory of aging states that accumulated damage to vital parts of cells leads to cellular aging and death.

D)

Mutations in BRCA1 and BRCA2 have been associated with increased risk for developing breast and ovarian cancer.

Ans:

D

Feedback:

Nonstochastic theories focus on genetic influences that determine physical condition, occurrence of disease, age of death, cause of death, and other factors contributing to longevity. Many genes that are associated with the human life span are not “longevity genes,” per se. For example, because mutations in the tumor suppressor genes BRCA1 and BRCA2 increase mortality rates associated with breast and ovarian cancer, they are rare among long-lived women. The mitochondrial DNA damage theory, oxidative free radical theory, and wear-and-tear theory are all stochastic theories of aging.

2.

A community health nurse is working with an 81-year-old female client who states that she has made a concerted effort throughout her life to protect her skin from the sun and regularly applies topical moisturizers. The client is lamenting the fact that her skin’s appearance has nonetheless deteriorated in recent years. Which of the following statements best captures a fact that the nurse should take into consideration when crafting a response to the client?

A)

The epidermal layer of the skin inevitably thins as part of the normal aging process, lending a transparent appearance to the skin.

B)

Skin becomes weaker and less elastic in older adults because of the rearrangement of fibrin and keratin.

C)

Skin becomes more fragile and prone to hematomas because of impaired vascularity.

D)

Output of sebaceous glands declines, with accompanying reductions in sweat production.

Ans:

C

Feedback:

Impaired vascularity and cellularity cause the skin of older adults to be prone to subcutaneous bleeding, resulting in senile purpura. The dermal, rather than epidermal, layer becomes thinner, and weakness is a result of collagen rearrangement rather than fibrin. Sebaceous glands produce sebum not sweat.

3.

A physiotherapist (PT) at an assisted living facility for older adults is leading an exercise class for the residents. Part of the PT’s introductory class is an explanation of the health problems that can be mitigated by physical activity and those that are considered inevitabilities of the aging process. Which of the following phenomena would the PT most justifiably characterize as modifiable?

A)

Reduction in density of the trabecular bone

B)

Gradual decline in physical reaction time

C)

Overall reduction in muscle strength

D)

Decline in height

Ans:

C

Feedback:

While a general reduction in muscle strength is a normal, age-related change, this can be slowed significantly by regular physical activity. Loss of bone density in the trabecular bone, decreases in reaction time, and loss of height are less modifiable.

4.

While taking BP for a new geriatric patient, the nurse notes that his BP is 162/70. When questioned by the nurse, the patient states, “That’s a pretty good BP for me. My upper number is usually higher.” Based on this finding, the nurse should further collect data related to which of the following body systems? Select all that apply.

A)

Detailed history surrounding cardiac events like chest pain or pressure

B)

Any paresthesia in limbs or noticeable facial drooping

C)

Decrease in urine output with increase in edema in the feet/legs

D)

Noticeable change in skin color (yellow), especially around the abdominal area

E)

Painless lumps palpated on his neck and cervical spine

Ans:

A, B, C

Feedback:

An elevation in systolic BP accompanied by a normotensive diastolic pressure causes a dramatic increase in pulse pressure. Thus, aggressive treatment of systolic hypertension is recommended and has been shown to demonstrate a reduction in stroke, heart failure, kidney disease, and other complications.

5.

A geriatrician has ordered an echocardiogram and stress test for an 80-year-old male client in an effort to gauge the client’s cardiovascular health status. Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?

A)

Increased resting, supine heart rate

B)

Low maximal heart rate and cardiac output

C)

Increased left ventricular wall thickness

D)

Delayed left ventricular filling

Ans:

A

Feedback:

In older adults, resting heart rate stays the same or decreases slightly. Answers A, B, and C all capture normal, age-related cardiovascular changes.

6.

A nurse provides care for a number of older adult residents of a long-term care facility. Which of the following events from the last shift is most deserving of further assessment and possible interventions?

A)

An 83-year-old female client complains of the glare of the fluorescent lights off the floor of the facility.

B)

A 79-year-old male client displays unprecedented forgetfulness.

C)

A 91-year-old male client who has been newly admitted displays balance problems when ambulating.

D)

A 90-year-old long-term resident displays decreased motor strength.

Ans:

B

Feedback:

While any abrupt change in status would warrant further examination, decreased strength, light sensitivity, and balance problems are all considered normal accompaniments to the aging process. Cognitive changes, such as a new onset of forgetfulness, are more likely to be pathologic in nature and deserving of further assessment.

7.

The educator of a geriatric, subacute medical unit in a hospital is oriented new staff and teaching orientees’ strategies for communicating with older adults with impaired hearing. Which of the following teaching points is most justifiable?

A)

“Speak slowly and directly to these clients.”

B)

“Avoid complex or abstract ideas when you’re talking.”

C)

“Increase the volume of your speech as much as possible.”

D)

“Choose simple, short words to minimize confusion.”

Ans:

A

Feedback:

Slow, direct speech is a useful communication technique when dealing with clients who are hard of hearing. It is not necessary to avoid complex ideas or always utilize short, simple vocabulary, since hearing deficits are not synonymous with cognitive deficits. Speaking too loudly is counterproductive.

8.

An 81-year-old female is attending a scheduled visit to her family physician. The client asks her doctor why it is that she and her peers seem to get sick frequently, in spite of their efforts to stay active and eat nutritiously. Which of the following responses best captures an aspect of the immune function of older adults?

A)

“It’s normal that the function and resiliency of your immune system decrease with age.”

B)

“Normal, age-related changes combined with outside factors make older adults more susceptible to getting sick.”

C)

“Your body produces fewer antibodies as you age, making you more vulnerable to infections than younger people.”

D)

“With a healthy lifestyle and proper medical treatment, you can generally maintain the same immune function as younger people.”

Ans:

B

Feedback:

Infections are more prevalent among older adults than younger adults, a situation that results partly from compromised immune function but mostly from the interplay between environmental factors and age-related changes. Illness is not entirely attributable to decreased immune function, and older adults do not necessarily produce fewer antibodies.

9.

One of the residents in a long-term care facility has developed numbness, tremor, and gross lack of coordination of muscle movements in his lower limbs. The nurse knows that this may be caused by

A)

lack of hydrochloric acid secretion.

B)

vitamin B₁₂ deficiency.

C)

high intake of calcium products.

D)

loss of parietal cells due to gastric ulcerations.

Ans:

B

Feedback:

Vitamin B₁₂ deficiency also can cause neurologic abnormalities such as peripheral neuropathy (numbness and tremor), ataxia (loss of coordination of muscle movements), and even dementia. Lack of hydrochloric acid secretions results in impaired gastric absorption. Loss of parietal cells causes a decrease in HCl acid production.

10.

As a follow-up to the introduction of a new medication regimen for an older adult client, the physician is interpreting the client’s recent blood work, paying particular attention to the client’s serum creatinine (Cr) levels (normal range 0.6 to 1.2 mg/100 mL) and glomerular filtration rate or GFR (normal value >60 mL/minute). Which of the following lab results would be considered typical of an older adult with impaired renal function?

A)

Cr 1.8; GFR 66

B)

Cr 2.3; GFR 30

C)

Cr 0.5; GFR 58

D)

Cr 1.1; GFR 22

Ans:

D

Feedback:

Due to decreased muscle mass and consequent decrease in creatinine production, older adults often maintain normal creatinine levels even in the presence of impaired glomerular filtration and low GFR.

11.

A nurse who is visiting a seniors’ wellness center is teaching a group of older adult women about sexual activity among older adults. Which of the following teaching points best captures the reality of sexual activity among older adults?

A)

“Androgen replacement therapy for older men can help resolve erectile function and low libido.”

B)

“Cessation of estrogen production after menopause makes sexual activity rarely possible for older women.”

C)

“You can expect the duration and intensity of sexual response to decrease with age.”

D)

“With education, sexual pleasure and frequency can remain similar to that of younger adults.”

Ans:

C