Which of the following assessment data will the nurse anticipate finding on the older adult? Select all that apply.
Slower reaction time
Decreased intestinal motility
Increased risk for respiratory infections
Increased bladder capacity
Decalcification of bones
Correct Answer : A,B,C,E
Choice A reason: This is a correct answer. Slower reaction time is a common finding on the older adult, as the nervous system becomes less efficient and responsive with age. The older adult may have difficulty processing information, responding to stimuli, or performing complex tasks. The nurse should assess the older adult's cognitive and sensory function, and provide them with safety and assistance as needed.
Choice B reason: This is a correct answer. Decreased intestinal motility is a common finding on the older adult, as the digestive system becomes slower and weaker with age. The older adult may have problems with constipation, indigestion, or malabsorption. The nurse should assess the older adult's bowel habits, dietary intake, and nutritional status, and provide them with education and intervention as needed.
Choice C reason: This is a correct answer. Increased risk for respiratory infections is a common finding on the older adult, as the immune system becomes less effective and protective with age. The older adult may have more susceptibility to viruses, bacteria, or fungi that can cause pneumonia, bronchitis, or tuberculosis. The nurse should assess the older adult's respiratory function, symptoms, and history, and provide them with prevention and treatment as needed.
Choice D reason: This is not a correct answer. Increased bladder capacity is not a common finding on the older adult, as the urinary system becomes smaller and less elastic with age. The older adult may have problems with urinary incontinence, retention, or infection. The nurse should assess the older adult's urinary habits, output, and quality, and provide them with education and intervention as needed.
Choice E reason: This is a correct answer. Decalcification of bones is a common finding on the older adult, as the skeletal system becomes less dense and strong with age. The older adult may have problems with osteoporosis, fractures, or arthritis. The nurse should assess the older adult's bone health, mobility, and pain, and provide them with education and intervention as needed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not the correct answer. Depression is a mental disorder that affects the mood, thoughts, and behavior of the client. It causes persistent feelings of sadness, hopelessness, or emptiness, as well as loss of interest, motivation, or pleasure in activities. Depression may cause some physical symptoms, such as fatigue, insomnia, or weight changes, but it does not cause dry eyes or frequent urination.
Choice B reason: This is not the correct answer. Fibromyalgia is a chronic condition that affects the muscles, joints, and nerves of the client. It causes widespread pain, stiffness, and tenderness, as well as fatigue, sleep problems, and cognitive difficulties. Fibromyalgia may cause some symptoms that overlap with menopause, such as dry eyes or weight gain, but it does not cause frequent urination.
Choice C reason: This is the best answer. Menopause is the natural transition that occurs when the ovaries stop producing eggs and hormones, such as estrogen and progesterone. It causes the menstrual cycle to end, and the client to experience various physical and emotional changes. Menopause may cause symptoms such as dry eyes, fatigue, poor sleep patterns, weight gain, and frequent urination, as well as hot flashes, night sweats, mood swings, and vaginal dryness.
Choice D reason: This is not the correct answer. Dehydration is a condition that occurs when the body loses more fluid than it takes in. It causes the blood volume and pressure to drop, and the body to function less efficiently. Dehydration may cause symptoms such as fatigue, dry mouth, headache, and dizziness, but it does not cause dry eyes, weight gain, or frequent urination. In fact, dehydration may cause the opposite of frequent urination, which is reduced or dark urine.
Correct Answer is D
Explanation
Choice A reason: This is not an indicator of appropriate neurological development. Appropriate weight is a measure of the physical growth and nutritional status of the baby. It is influenced by the baby's genetics, gestational age, birth weight, feeding habits, and health conditions. Appropriate weight does not reflect the baby's brain development or function.
Choice B reason: This is not an indicator of appropriate neurological development. Vernix caseosa is a white, cheesy substance that covers the skin of the baby in the womb. It protects the skin from the amniotic fluid and helps with temperature regulation and infection prevention. Vernix caseosa is mostly shed before or during birth, and does not relate to the baby's brain development or function.
Choice C reason: This is not an indicator of appropriate neurological development. Presence of lanugo is a fine, soft hair that covers the body of the baby in the womb. It helps to keep the baby warm and hold the vernix caseosa on the skin. Presence of lanugo is usually lost before or shortly after birth, and does not indicate the baby's brain development or function.
Choice D reason: This is the best answer. Expected reflexes are involuntary movements or responses that the baby makes in reaction to certain stimuli. They are controlled by the nervous system and indicate the baby's brain development and function. Expected reflexes include the rooting, sucking, grasping, Moro, and Babinski reflexes. The nurse should assess the presence, strength, and symmetry of these reflexes during the well-baby check.
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