In addition to seasonal flu (influenza) vaccine and Td or Tdap vaccine (Tetanus, diphtheria, and pertussis), you should also get HPV vaccine, which protects against the types of human papillomaviruses (HPV) that cause most cervical, anal, and other cancers, as well as genital warts. CDC recommends:
- HPV vaccination for all preteens at age 11 or 12 years (can be given starting at age 9 years).
- HPV vaccination for everyone through age 26 years, if not vaccinated already.
HPV vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.
In addition, the hepatitis B vaccine is recommended for all adults age 19 through 59 years. The vaccine provides protection from hepatitis B which can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.
Some vaccines may be recommended for adults because of particular job or school-related requirements, health conditions, lifestyle or other factors. For example, some states require students entering colleges and universities to be vaccinated against certain diseases like meningitis due to increased risk among college students living in residential housing. Read more about state mandates.
Talk with your doctor or other healthcare provider to find out which vaccines are recommended for you at your next medical appointment.
Under the Affordable Care Act, insurance plans that cover children now allow parents to add or keep children on the health insurance policy until they turn 26 years old. For more information, see Can children stay on a parent’s plan through age 26? or healthcare.gov.
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The community health nurse who focuses on health maintenance and preventative care knows which factor is most important in determining an individual's likelihood to participate in health maintenance practices?
A) Culture
B) Motivation
C) Knowledge
D) Access to health care
B) Motivation
The single most important factor in determining an individual's likelihood to participate in health maintenance practices is that individual's motivation to live a healthy life. Culture, knowledge, and access to health care are important factors, but motivation is the most important.REF: Pages 78-79
The nurse is educating the patient on proper dental hygiene. Which statement, if made by the patient, indicates a need for further education?
A)
"I will brush twice daily with fluoride toothpaste."
B) "Gum health is improved by flossing between teeth daily."
C) "I will replace my firm-bristle brush often to ensure the best clean."
D) "I can use mouthwash to freshen my breath, but not instead of brushing my teeth."
C) "I will replace my firm-bristle brush often to ensure the best clean.
The patient should brush his teeth twice daily with a soft-bristle brush with fluoride toothpaste, floss daily, and use mouthwash only to freshen the breath. Firm-bristled brushes can cause damage to the teeth and gums and should be avoided.REF: Pages 77-78
The older adult presents to the clinic complaining of persistent dry mouth. The nurse knows this can most likely be attributed to which cause?
A) Dehydration due to decreased oral intake
B) Age-related decrease in saliva production
C) Side effect of many common medications
D)
Excessive use of hard candy and caffeinated beverages
C) Side effect of many common medications
Many medications taken by older adults result in dry mouth. It is not an age-related change. Many adults do not experience thirst in response to dehydration, which worsens dehydration. Although excessive use of hard candy and caffeinated beverages worsen dry mouth, they do not necessarily cause dry mouth.REF: Page 77
The nurse caring for an African-American woman knows this woman is vulnerable to which health disparities due to her ethnicity?
Select all that apply.
A) Obesity
B) Hypertension
C) Breast cancer
D) Cervical cancer
E) Stomach cancer
F) Diabetes mellitus
A) Obesity
B) Hypertension
D) Cervical cancer
E) Stomach cancer
F) Diabetes mellitus
African-American women are at an increased risk for obesity, hypertension, cervical cancer, stomach cancer, and diabetes mellitus. White women are at an increased risk for breast cancer.REF: Page 78
The home health nurse knows age-related sensory changes can increase a patient's risk for falls in the home. Which age-related sensory changes can increase a patient's risk for falls in the home?
A) Sight
B) Taste
C) Touch
D) Hearing
A) Sight
Common age-related changes to the patient's sight can increase the patient's risk for falls in the home. Many safety issues can result from age-related changes to the patient's senses of touch, taste, and hearing.REF: Page 79
The nurse is educating the patient with multiple comorbidities and his family on ways to reduce the risk of adverse drug interactions associated with polypharmacy in the older adult. Which statement, if made by the patient, indicates an understanding of the education?
A) "I should wear a medical alert bracelet to inform others of my health conditions."
B) "When I get home, I will use a weekly pill organizer to separate my pills for the week."
C) "I will diligently research any over-the-counter pills or herbal remedies before I begin taking them."
D) "I will keep a list of medications, dosages, reasons, and the names of the providers who prescribed them with me at all times."
D) "I will keep a list of medications, dosages, reasons, and the names of the providers who prescribed them with me at all times."
Polypharmacy is a life-threatening problem for older adults with multiple comorbidities who are seen by multiple specialists. In order to prevent adverse drug interactions associated with polypharmacy, the patient should keep current a list of medications to show to each provider. A pill organizer is helpful to ensure the proper dosages of each medication are taken and not forgotten, but is less helpful in preventing adverse drug interactions. The patient should discuss any herbal remedies with his provider before taking them, rather than just diligently researching them. A medical alert bracelet may be helpful for this patient, but is not the best option for preventing drug interactions.REF: Page 76
The older patient presents to the clinic with food-stained and rumpled clothing, body odor, and unwashed hair. The nurse should be sure to ask questions to detect issues in which areas? Select all that apply.
A) Dementia
B) Depression
C) Hearing loss
D) Vision changes
E) Functional ability
A) Dementia
B) Depression
D) Vision changes
E) Functional ability
The older adult who presents to the clinic with an unkempt appearance and body odor may be experiencing dementia, depression, vision changes, and changes to his or her functional ability.REF: Page 79
The home health nurse is planning care for an older adult with diabetes mellitus. What is the best way to ensure this patient is compliant with the care plan?
A) Create easily attainable goals for the patient
B) Incorporate common practices from the patient's culture
C) Include the patient in the process of selecting goals and interventions
D) Request information from the patient's family about the patient's
current diet
C) Include the patient in the process of selecting goals and interventions
In order to promote the patient's compliance with the care plan, the nurse should include the patient in the process of selecting goals and interventions. It is also helpful to create easily attainable goals (at least initially) for the patient, incorporate common practices from the patient's culture (as long as they are also important to the patient), and work with the patient's family as well.REF: Page 85
The 75-year-old patient presents to the clinic for her annual exam. The nurse is reviewing her immunization record and notes the patient received her pneumococcal vaccine at age 73, flu vaccine at age 74, and Td booster at age 64, but has never received the shingles vaccine or the hepatitis B vaccine. The nurse learns the patient has a history of chicken pox at age 8, has been married to the same man for 52 years, and has never used IV drugs. Which vaccine(s) should the nurse plan to administer to this patient? Select all that apply.
A) Td booster
B) Flu vaccine
C) Shingles vaccine
D) Hepatitis B vaccine
E) Pneumococcal vaccine
A) Td booster
B) Flu vaccine
C) Shingles vaccine
The Td booster should be administered every 10 years, the flu vaccine every year, and the pneumococcal vaccine every 10 years. Therefore, the patient needs an updated Td booster and flu vaccine but does not need another pneumococcal vaccine until age 83. The shingles vaccine is given to older adults regardless of whether or not they have had chicken pox or shingles in the past; however, this decision should be discussed between the provider and the patient as there are no recommendations for this vaccine. Administration of the hepatitis B vaccine is a decision that must be made between the patient and the provider, but this patient does not appear to be at risk for hepatitis B based on lifestyle choices, so administration is unlikely.REF: Page 75
The nurse is caring for an individual from a culture with which she is unfamiliar. What is the best way to provide culturally appropriate care for this patient?
A) Research the patient's culture online
B) Consult with a religious official from the patient's culture
C) Ask the patient which cultural practices are important to her
D)
Discuss this patient's care with another nurse who is a member of the same culture as the patient
C) Ask the patient which cultural practices are important to her
The best source of information on the cultural practices that are important to the patient is the patient herself. It would be less helpful to research the patient's culture online, consult with a religious official from the patient's culture, or discuss the patient's care with another nurse who is a member of the same culture as the patient because of differences amongst members of each culture.REF: Page 78
For a healthy older adult, with no known chronic health conditions, what diagnostic testing should occur on an annual basis?
A) Screening for hearing loss
B) Blood glucose for diabetic screening
C) Glaucoma screening
D) Blood cholesterol screening
C) Glaucoma screening
Vision should be checked yearly to monitor for glaucoma. Screening for hearing loss or diabetes and electrocardiograms are not routinely performed unless there is indication of a problem. Blood cholesterol testing is done every five years. (p. 75)
The home health nurse is assessing an older patient who has a history of chronic obstructive pulmonary disease and hypertension. Which finding is most likely to prompt the nurse to immediately call the health care provider?
A) Patient seems more irritable than usual
B) Patient has gained two pounds in the past two weeks
C) Patient has orthopnea during the night
D) Patient reports a severe unremitting headache
D) Patient reports a severe unremitting headache
The home health nurse is likely to report all of the findings to the health care provider; however, a severe unremitting headache in a patient with hypertension could be a symptom of stroke. This finding would require immediate evaluation. (p. 76)
An older adult says to the nurse, "Why should I bother to see the doctor about my problems? It's just old age." What is the nurse's best response?
A) "Well, you can't really be sure that it's just old age"
B) "That's your choice, but you really should reconsider"
C) "Your symptoms could be an early sign of illness"
D) "Why do you think your problems are just old age?"
C) "Your symptoms could be an early sign of illness"
Symptoms can be an early sign of illness. This response gives the patient a rational reason for getting checked. Options A and B are also correct but are vague and generalized. Discussion of the patient's beliefs and thoughts is another option, but the nurse is still likely to advise that symptoms could be a sign of illness. (p. 79)
The patient's daughter tells the nurse that her mother does not take her medication as frequently as prescribed. Which intervention would the nurse perform first?
A) Suggest that a pill-box reminder might be useful
B) Assess the patient for signs of dementia
C) Offer the patient additional education about her medications
D) Try to determine the patient's reasons for medication noncompliance
D) Try to determine the patient's reasons for medication noncompliance
The nurse would try to determine the cause(s) of the behavior. Once the cause is
identified, then the nurse can use interventions, which may include the other options. The patient could also have beliefs or financial concerns that affect compliance or the patient may be trying to avoid unpleasant side effects. (pp. 84-85)
When the nurse asks the patient if he has been performing the mobility and balance exercises as directed by the physical therapist, the patient responds, "That type of exercise wasn't really helping, so I stopped." What is the nurse's best response?
A) "Your doctor ordered the physical therapy to help you improve your ability to walk"
B) "What do you think would help you to maintain your ability to walk independently?"
C) "Oh, you shouldn't have given up; it's really too soon to tell if the exercises were helping"
D) "Well, you do have the right to discontinue any therapy whenever you
want to
B) "What do you think would help you to maintain your ability to walk independently?"
Involving the patient in the plan of care may help to increase compliance. Also,
the patient may not like the specifically recommended exercises but is likely to want to be able to walk independently. The patient may not believe that exercising is useful, despite what the
doctor has ordered. Contradicting the patient's decision creates defensiveness, and
it would be more useful to give time parameters (i.e., can't expect to see improvement for 3-4 weeks). The patient is allowed to discontinue therapies, but the patient should have options and be encouraged to explore options as appropriate. (p. 85)
What is the activity that best promotes health maintenance for the typical older adult?
A) One hour of low-impact tai chi per week
B) One 30-minute walk, 3-5 times a week
C) Step aerobics for
20 minutes, 2 times a week
D) Riding for 5-10 minutes on a stationary bike, daily
B) One 30-minute walk, 3-5 times a week
Regular exercise should be a part of any daily plan for older adults. Exercise can help keep the joints flexible, maintain muscle mass, control blood glucose levels and weight, and promote a sense of well-being. To be of most benefit, exercise should consist of at least 30 minutes of continuous activity. The type, level, and
amount of exercise that is most beneficial differ for each person and should be based on physician recommendations.
REF: Page 74
The nurse recognizes that regular dental visits are:
A) Necessary for only those older adults who still have their natural teeth.
B) Recommended on a yearly basis for all older adults, even those with dentures.
C) Not necessary if the person brushes and flosses properly three times a day.
D) Desirable,
but not necessary unless pain or another problem occurs.
B) Recommended on a yearly basis for all older adults, even those with dentures.
Dental examinations should be obtained, and inspection of the oral cavity performed, on a regular basis (at least once a year) for all older adults. Older adults who wear dentures still need regular oral examinations because people older than 65 years of age account for more than half of the new cases of oral cancer
each year.
REF: Page 76
An older adult does not follow through with health recommendations from the primary health care provider. The older adult does not take prescribed medications or keep medical appointments. For which diagnosis should the nurse formulate a care plan?
A) Noncompliance
B) Knowledge deficit
C) Disturbed thought process
D) Impaired health seeking behavior
A) Noncompliance
A person is said to be noncompliant when he or she fails to follow through with recommended health practices. Failing to take prescribed medications, failing to attend scheduled medical appointments, and failing to follow prescribed diets are examples of noncompliant behaviors.
REF: Page 84
Which immunizations should older adults receive on a yearly basis? (Select all that apply.)
A) Pneumonia vaccine
B) Influenza vaccine
C) Tetanus
vaccine
D) Polio vaccine
E) Hepatitis-B vaccine
B) Influenza vaccine
The pneumonia vaccine is given starting at 65 or 70 years of age. Repeat vaccination every 10 years is recommended. The influenza vaccine must be obtained on a yearly basis, usually in the fall, because the strain of the virus changes frequently. Although tetanus infection is rare in the United States, approximately half of tetanus cases affect older adults. People who have not
yet had the Tdap vaccine should receive one dose in place of one of their ten-year tetanus (Td) boosters. Specific injuries may require a booster even if 10 years have not elapsed. If someone has never been immunized, they should consult with their physician but will likely start with the Tdap vaccine. Polio vaccine is not recommended to be received on a yearly basis. The need for the hepatitis B immunization is based on individual risk factors and should be discussed with a physician. Typhoid
vaccine is not recommended to be received on a yearly basis.
REF: Pages 75-76
When attempting to help an older adult improve his or her health-maintenance practices, the nurse will need to assess which factors? (Select all that apply.)
A) Physical strength and endurance
B) Availability of transportation
C) Cultural beliefs
D) Cognitive and sensory changes
E) Socioeconomic status
F) Religious beliefs
G) Social support
system
H) Educational level
C) Cultural beliefs
E) Socioeconomic status
F) Religious beliefs
H) Educational level
Health-maintenance practices in older adults are influenced by personal beliefs, religious and cultural beliefs, socioeconomic status, education, and life experiences.
REF: Page 78
Your patient, Mr. Palakiko, tells you he understands that he is at greater risk of certain diseases because of his Pacific Island heritage. Based on what you have learned, which disorder(s) is he likely to be at risk for? (Select all that apply.)
A) Obesity
B) Stomach cancer
C) Diabetes mellitus
D) Hypertension
B) Stomach cancer
C) Diabetes mellitus
Pacific Islanders are at increased risk for diabetes and stomach cancer. The highest rates of obesity are present among African-American, American Indian/Alaskan Native, and Hispanic
American populations. The highest rates of hypertension are present among the African-American population.
REF: Page 78
What is the activity that best promotes health maintenance for the typical older adult?
A) One hour of low-impact tai chi per week
B) One 30-minute walk, 3-5 times a week
C) Step aerobics for 20 minutes, 2 times a week
D) Riding for 5-10 minutes on a stationary bike, daily
...
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