A nurse is providing teaching to a client about ways to improve their health.
Which of the following modifiable risk factors should the nurse include?

Choice A rationale:

Widened peripheral vision. This choice is not an expected change in an older adult's vision. As individuals age, peripheral vision may diminish, but it doesn't typically widen. Therefore, this choice is not appropriate.

Choice C rationale:

Eyes with large pupils. Older adults often experience changes in the size of their pupils due to the aging process. Pupils may become smaller and less responsive to light, not larger. Thus, this choice is not accurate.

Choice D rationale:

Infections of the eye. While eye infections can occur in any age group, there's no specific reason to monitor an older adult for eye infections unless there are signs or symptoms suggesting an issue. It's not a routine aspect of care for older adults. Now, let's discuss the rationale for the correct answer, choice B:

Choice B rationale:

Increase in accommodation to near vision. This is the correct answer because it is a common age-related change in vision known as presbyopia. As individuals age, their ability to accommodate or focus on near objects diminishes. This change typically begins in the early 40s and progresses over time. It's a result of the lens of the eye becoming less flexible. Older adults may need reading glasses or bifocals to improve their near vision. The nurse should plan to monitor for this change as part of routine care for an older adult.

Choice A rationale:

The statement, "Depression," does not align with the client's promise to go to church every day if they get better. Depression is one of the Kubler-Ross stages of grief, but it does not reflect the client's behavior of making promises to engage in specific activities if they improve. Therefore, this choice does not represent the client's current stage of grief accurately.

Choice B rationale:

The client's statement, "If I get better, I promise to go to church every day," indicates that the client is in the bargaining stage of grief. During this stage, individuals often make deals or promises in an attempt to reverse or delay the terminal diagnosis or adverse outcome. This response reflects the typical behavior associated with the bargaining stage, making it the correct choice.

Choice C rationale:

The statement, "Denial," is not consistent with the client's promise to go to church every day. Denial is a stage in which individuals may refuse to accept the reality of their situation and may not engage in making promises or deals. Therefore, this choice does not accurately represent the client's current stage of grief.

Choice D rationale:

The statement, "Anger," does not align with the client's promise to go to church every day. Anger is another stage of grief, characterized by frustration and resentment, but it does not correspond to the client's behavior of making promises. This choice does not accurately reflect the client's current stage of grief.