Physiological Changes with Aging

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Question 1:

A nurse is assessing the skin of an older adult client. Which of the following findings is a normal age-related change in the integumentary system?

Explanation

The correct answer isD.

Decreased perspiration.This is because the sweat glands become less active with aging, resulting in reduced sweating and dryness of the skin.Decreased perspiration can also affect the body’s ability to regulate its temperature and may cause heat intolerance.

Choice A is wrong becauseincreased skin vascularityis not a normal age-related change in the integumentary system.In fact, the blood vessels in the skin become thinner and less elastic, resulting in decreased perfusion and a paler skin tone.

Choice B is wrong becausedecreased skin fragilityis not a normal age-related change in the integumentary system.On the contrary, the skin becomes thinner, less elastic, and more prone to splitting, cracking, and infections due to reduced collagen and elastin production, decreased mitosis in the epidermis, and lowered immunity.

Choice C is wrong becauseincreased sebaceous gland activityis not a normal age-related change in the integumentary system.Rather, the sebaceous glands produce less sebum, which contributes to the dryness and loss of moisture in the skin.

Normal ranges for some of the parameters related to the integumentary system are:.

• Skin thickness: varies depending on body location, but generally ranges from 0.5 mm to 4 mm.

• Skin elasticity: measured by the Cutometer device, which uses negative pressure to lift the skin and calculate its elasticity.

A higher value indicates more elastic skin.The average elasticity value for young adults is 0.82, while for older adults it is 0.57.

• Skin moisture: measured by the Corneometer device, which uses electrical capacitance to assess the hydration level of the stratum corneum (the outermost layer of the skin).

A higher value indicates more hydrated skin.The average moisture value for young adults is 62.8, while for older adults it is 51.3.

• Perspiration: measured by the Evaporimeter device, which uses a humidity sensor to detect the amount of water vapor lost from the skin surface.

A higher value indicates more perspiration.The average perspiration value for young adults is 13.9 g/m2/h, while for older adults it is 9.8 g/m2/h.


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Question 2:

A nurse is teaching a group of older adults about the respiratory system changes that occur with aging. Which of the following statements should the nurse include? (Select all that apply.).

Explanation

The correct answer is A, B, C, and E.These statements reflect the respiratory system changes that occur with aging, such as decreased respiratory muscle strength, decreased lung elasticity and recoil, decreased cough and gag reflexes, and decreased ciliary action and mucus production.

These changes can impair gas exchange, increase the risk of infections, and reduce exercise capacity.

Choice D is wrong because it states the opposite of what happens with aging.

Vital capacity is the maximum amount of air that can be exhaled after a maximum inhalation.

Residual volume is the amount of air that remains in the lungs after a maximum exhalation.With aging, vital capacity decreases and residual volume increases due to the loss of lung elasticity and airway closure.

This reduces the amount of fresh air that can enter the lungs and increases the amount of stale air that remains in the lungs.


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Question 3:

A nurse is caring for an older adult client who has dry skin and complains of feeling cold.

Which of the following statements should the nurse make?

Explanation

The correct answer is D.

“You should apply moisturizer to your skin after bathing.” This statement is based on the fact that dry skin is a common problem among older adults, especially in cold or dry weather.Applying moisturizer after bathing can help to lock in the moisture and prevent further water loss from the skin.

Choice A is wrong because drinking more water may not be enough to hydrate the skin if the skin barrier is impaired or damaged.Drinking water is important for overall health, but it does not directly affect the moisture content of the skin.

Choice B is wrong because avoiding soap and hot water when bathing may not be sufficient to prevent dry skin.

Soap can strip the natural oils from the skin, but so can hot water.It is recommended to use mild, non-soap cleansers and warm water instead of hot water when bathing.

Choice C is wrong because wearing layers of clothing to keep warm may not address the underlying cause of feeling cold.Older adults may feel cold more than usual due to various factors, such as thinning of the skin, decreased blood circulation, reduced muscle mass, or hormonal changes.

Wearing layers of clothing may help to maintain body temperature, but it does not treat the cause of feeling cold.

Normal ranges for skin moisture and body temperature vary depending on individual factors, such as age, health status, environment, and activity level.

However, some general guidelines are:.

• Skin moisture: The skin should feel soft and smooth, not rough or scaly.

The skin should not have cracks, flakes, or redness.The skin should have a normal color, not pale or grayish.

• Body temperature: The normal body temperature for adults is around 98.6°F (37°C), but it can vary slightly depending on the time of day, activity level, and other factors.A body temperature below 95°F (35°C) is considered hypothermia and requires immediate medical attention.


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Question 4:

A nurse is educating an older adult client about the changes in hair and nails that occur with aging. Which of the following statements should the nurse expect the client to make?

Explanation

The correct answer is A.“I may notice my hair becoming thinner and grayer as I age.” This statement reflects the common changes in hair that occur with aging, such as reduced melanin production, slower growth rate, and smaller hair strands.

Choice B is wrong because nails do not grow faster and stronger with age, but rather more slowly and may become dull and brittle.

Choice C is wrong because hair does not become more oily and curly with age, but rather drier and finer.

Choice D is wrong because nails do not become smoother and shinier with age, but rather yellowed and opaque.

Normal ranges for hair and nail growth vary depending on factors such as genetics, nutrition, health conditions, and environmental exposure.

However, some general estimates are:.

• Fingernails grow about 3 mm per month and toenails grow about 1 mm per month.

• Hair grows about 0.5 inches per month and loses about 50 to 100 strands per day.

• Hair color changes from about 30% gray at age 50 to about 50% gray at age 70.


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Question 5:

A nurse is reviewing the chest x-ray of an older adult client. Which of the following findings is a normal age-related change in the thorax?

Explanation

The correct answer is A.

Increased anteroposterior diameter.

This is a normal age-related change in the thorax that results from changes in the bones and muscles of the chest and spine.The ribcage becomes less flexible and more rounded, which increases the front-to-back dimension of the chest.

This can affect the lung function and breathing capacity of older adults.

Choice B is wrong because decreased kyphosis means reduced curvature of the spine, which is not a normal age-related change.In fact, kyphosis tends to increase with aging due to osteoporosis and vertebral compression fractures.

Choice C is wrong because increased lung expansion means greater ability to fill the lungs with air, which is not a normal age-related change.In fact, lung expansion tends to decrease with aging due to loss of elasticity and shape of the air sacs (alveoli) and weakening of the respiratory muscles.

Choice D is wrong because decreased calcification means reduced deposition of calcium in the tissues, which is not a normal age-related change.In fact, calcification tends to increase with aging, especially in the costal cartilages that connect the ribs to the sternum.

This can make the chest wall more rigid and less compliant.

Normal ranges for anteroposterior diameter vary depending on age, sex, height and weight, but generally it should be less than the transverse diameter (the side-to-side dimension of the chest).

A ratio of anteroposterior to transverse diameter greater than 0.9 is considered abnormal and may indicate chronic obstructive pulmonary disease (COPD).


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Question 6:

A nurse is assessing a client who is 75 years old. Which of the following findings is most likely related to the decreased contractile strength of the myocardium in older adults?

Explanation

The correct answer is B. Decreased stroke volume.

Stroke volume is the amount of blood pumped by the left ventricle of the heart in one contraction.

The contractile strength of the myocardium determines how much blood is ejected with each beat.As people age, the myocardium becomes less elastic and less responsive to catecholamines, which can reduce the contractile force and lower the stroke volume.

Choice A is wrong because increased heart rate is not related to the decreased contractile strength of the myocardium, but rather to the decreased responsiveness of the baroreceptors, which regulate blood pressure.Older adults may have higher resting heart rates and lower maximum heart rates than younger adults.

Choice C is wrong because increased cardiac output is not related to the decreased contractile strength of the myocardium, but rather to the increased blood volume and cardiac workload that may occur with aging.Cardiac output is the product of stroke volume and heart rate, so a lower stroke volume would tend to decrease cardiac output.

Choice D is wrong because decreased peripheral resistance is not related to the decreased contractile strength of the myocardium, but rather to the decreased elasticity and increased stiffness of the arterial walls that may occur with aging.

Peripheral resistance is the opposition to blood flow caused by friction between the blood and the vessel walls.A higher peripheral resistance would increase the afterload on the heart and reduce the stroke volume.

Normal ranges for stroke volume are 60 to 100 mL/beat for men and 50 to 90 mL/beat for women.

Normal ranges for heart rate are 60 to 100 beats per minute for adults.

Normal ranges for cardiac output are 4 to 8 L/min for adults.

Normal ranges for peripheral resistance are 800 to 1200 dynes/sec/cm-for adults.


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Question 7:

A nurse is teaching a group of older adults about the effects of aging on the cardiovascular system. Which of the following statements should the nurse include? (Select all that apply.).

Explanation

The correct answer is A, D, and E.

Here is why:.

A. “You may experience dizziness when you stand up quickly.” This is true because aging causes the arteries and arterioles to become less elastic and less able to adjust the blood pressure quickly when the posture changes.This can lead to a drop in blood pressure when standing up, which can cause dizziness or fainting.

D. “Your blood vessels may become stiffer and narrower.” This is true because aging causes the walls of the arteries and arterioles to become thicker and stiffer, which reduces their compliance and increases the resistance to blood flow.This can lead to high blood pressure, atherosclerosis, and other cardiovascular diseases.

E. “Your heart may skip some beats or have extra beats.” This is true because aging causes changes in the electrical system of the heart, which can result in arrhythmias such as atrial fibrillation, premature ventricular contractions, or sinus bradycardia.These can cause irregular heartbeats that may be felt as palpitations or skipped beats.

B. “Your blood pressure may drop when you are resting.” This is false because aging does not cause a decrease in blood pressure at rest.

In fact, aging tends to increase the systolic blood pressure (the pressure when the heart contracts) due to the stiffening of the arteries.The diastolic blood pressure (the pressure when the heart relaxes) may remain normal or decrease slightly, resulting in a widened pulse pressure (the difference between systolic and diastolic pressures).

C. “Your heart may beat faster when you exercise.” This is false because aging does not cause an increase in heart rate during exercise.

In fact, aging tends to decrease the maximum heart rate that can be achieved during exercise due to the reduced responsiveness of the heart to adrenergic stimuli.The older heart also takes longer to recover after exercise.

Normal ranges for blood pressure are less than 120/80 mmHg for adults of any age.Normal ranges for heart rate are 60-100 beats per minute for adults of any age, but the maximum heart rate decreases with age according to the formula 220 minus age.


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Question 8:

A nurse is caring for a client who has dysphagia due to decreased esophageal motility.

Which of the following actions should the nurse take?

Explanation

The correct answer is B.

Instruct the client to tuck their chin when swallowing.

This action helps to prevent aspiration by closing off the airway and directing food and liquid into the esophagus.It also reduces the risk of food getting stuck in the throat or chest.

Choice A is wrong because thin liquids are more difficult to swallow and control for clients who have dysphagia due to decreased esophageal motility.They can easily enter the airway and cause choking or pneumonia.

Choice C is wrong because hot or spicy foods can irritate the esophagus and worsen the symptoms of dysphagia.They can also trigger reflux, which can damage the esophageal lining and cause narrowing or inflammation.

Choice D is wrong because elevating the head of the bed to 30 degrees during meals is not enough to prevent aspiration or regurgitation.The client should be sitting upright at 90 degrees or higher to facilitate swallowing and gravity.

Normal ranges for esophageal motility are:.

• Lower esophageal sphincter pressure: 10 to 45 mm Hg.

• Peristaltic amplitude: 30 to 180 mm Hg.

• Peristaltic duration: 2.5 to 6 seconds.

• Peristaltic velocity: 2 to 4.5 cm/s.


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Question 9:

A nurse is reviewing the laboratory results of a client who is 80 years old.The nurse notes that the client has low levels of iron, calcium and vitamin B12. Which of the following statements by the client indicates an understanding of this finding?

Explanation

The correct answer is A.

“I need to eat more foods that are rich in these nutrients.” This statement indicates that the client understands that low levels of iron, calcium and vitamin B12 can be caused by inadequate dietary intake of these nutrients.Iron, calcium and vitamin B12 are mainly found in animal-based foods, such as meat, eggs, milk and cheese.A diet lacking in these foods can lead to vitamin deficiency anemia, which is a condition where the body produces fewer and larger red blood cells that cannot carry enough oxygen.

Choice B is wrong because supplements may not be necessary or sufficient to correct these deficiencies.

Supplements can also interact with other medications or have side effects.The client should consult with their healthcare provider before taking any supplements.

Choice C is wrong because gastric acid inhibitors can actually worsen vitamin B12 deficiency.

Gastric acid inhibitors are medications that reduce the amount of stomach acid produced.However, stomach acid is needed to release vitamin B12 from food and to help it bind to a protein called intrinsic factor, which is essential for its absorption in the intestines.

Therefore, taking gastric acid inhibitors can impair vitamin B12 absorption and lead to deficiency.

Choice D is wrong because reducing dairy consumption can further lower calcium intake.

Dairy products are a good source of calcium, which is a mineral that helps build and maintain strong bones and teeth.Calcium deficiency can lead to osteoporosis, which is a condition where the bones become weak and brittle.

Normal ranges for iron, calcium and vitamin B12 in the blood are:.

• Iron: 50 to 170 micrograms per deciliter (mcg/dL) for men; 40 to 150 mcg/dL for women.

• Calcium: 8.5 to 10.2 milligrams per deciliter (mg/dL).

• Vitamin B12: 200 to 900 picograms per milliliter (pg/mL).


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Question 10:

A nurse is administering medications to a client who is 65 years old. The nurse knows that older adults are at increased risk for adverse drug reactions due to which of the following physiological changes?

Explanation

The correct answer is C.

Decreased liver function.Older adults are at increased risk for adverse drug reactions due to various physiological changes that affect the absorption, distribution, metabolism and excretion of drugs.One of these changes is the reduction in liver blood flow, size, drug-metabolizing enzyme content and function.This can result in slower or decreased metabolism of drugs, leading to higher plasma concentrations and increased risk of toxicity.

Choice A is wrong because older adults have decreased renal clearance, not increased.This means that drugs that are eliminated by the kidneys may accumulate in the body and cause adverse effects.

Choice B is wrong because older adults have decreased plasma protein levels, not increased.This means that drugs that are bound to plasma proteins may have higher free fractions and increased pharmacological effects.

Choice D is wrong because older adults have increased permeability of the blood-brain barrier, not decreased.This means that drugs that cross the blood-brain barrier may have enhanced central nervous system effects in older adults.

Normal ranges for liver function tests vary depending on the laboratory and the method used, but some common values are:.

• Alanine aminotransferase (ALT): 7-55 U/L.

• Aspartate aminotransferase (AST): 8-48 U/L.

• Alkaline phosphatase (ALP): 45-115 U/L.

• Total bilirubin: 0.1-1.2 mg/dL.

• Albumin: 3.5-5 g/dL.


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