The nurse is performing an assessment on an older adult client. What assessment data would indicate a potential complication associated with the skin of this client?

Correct Answer: A

Rationale: The correct answer is A: Crusting. In older adults, crusting on the skin can indicate a potential complication such as infection, dermatitis, or impaired wound healing. Crusting may result from dryness, scratching, or poor circulation. It is essential for the nurse to assess and address the underlying cause promptly to prevent further complications. B: Wrinkling is a normal part of aging and not necessarily indicative of a complication unless it is severe and associated with other symptoms. C: Thinning/loss of elasticity of skin is a common age-related change and may not always indicate a complication unless it is excessive. D: Crusting is a duplicate answer.

Correct Answer: C

Rationale: The correct answer is C because ethnicity involves recognized traditions, symbols, and literature. This statement aligns with the topic of culture and illness, as ethnicity plays a significant role in shaping cultural beliefs and practices related to health and illness. It highlights the importance of cultural elements in understanding how different ethnic groups perceive and address health issues. A: Culture is not the same as ethnicity; culture encompasses a broader range of beliefs and practices. B: This choice is incorrect as ethnic groups can have diverse origins and religions. D: Most members of an ethnic group do not exhibit identical cultural traits as cultural diversity exists within ethnic groups.

Correct Answer: B

Rationale: The correct answer is B: Statistically, neglect is the most common form of elder abuse. Neglect involves the failure to provide necessary care or assistance to an elderly person, making it a prevalent form of elder abuse. This is supported by research and studies on elder abuse cases. A is incorrect because elder abuse is often underreported compared to other forms of domestic violence. C is incorrect as many cases of elder abuse go unreported due to various reasons such as fear, shame, or lack of awareness. D is incorrect as healthcare practitioners are mandated to report any suspected cases of elder abuse, not just verified cases, to protect the well-being of the elderly.

Correct Answer: B

Rationale: The correct answer is B: Thyroid gland. The thyroid gland produces hormones that regulate metabolism. In older adults, decreased thyroid function, known as hypothyroidism, can lead to a decrease in metabolism. This can result in symptoms such as fatigue, weight gain, and slowed heart rate. A: Kidney - While the kidneys play a role in filtering waste and maintaining fluid balance, decreased kidney function typically does not directly impact metabolism. C: Brain - The brain plays a crucial role in regulating various bodily functions, but it does not directly control metabolism. D: Skeleton - The skeleton provides structural support and protects organs but does not directly influence metabolism.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Aging causes decreased collagen production, leading to decreased skin elasticity and thinning. 2. Loss of subcutaneous fat contributes to the appearance of aging skin. 3. Wrinkles and sagging are common signs of decreased skin elasticity in older adults. 4. Increased muscle mass, increased cardiac output, and increased renal filtration rate are not typical age-related changes. Summary: Skin changes such as decreased elasticity and thinning are common in older adults due to reduced collagen production and loss of subcutaneous fat. Increased muscle mass, cardiac output, and renal filtration rate are not typical age-related changes.

Correct Answer: D

Rationale: The correct answer is D because pursed lip breathing helps prevent airway collapse by maintaining positive pressure in the airways, reduces anxiety by promoting relaxation, and enhances effective breathing by improving oxygen exchange. Choice A is incorrect as pursed lip breathing does not directly prevent the build-up of secretions. Choice B is incorrect as comfort is not the primary purpose of pursed lip breathing. Choice C is incorrect as while pursed lip breathing can improve respiratory muscle function, its primary benefit lies in preventing airway collapse, reducing anxiety, and promoting effective breathing.

Correct Answer: D

Rationale: The correct answer is D because memory loss affecting daily functioning is a key indicator of dementia, not normal aging. Normal aging may involve some forgetfulness, but it typically does not significantly impact daily activities. Choice A is incorrect because difficulty recalling recent events can occur in both normal aging and dementia. Choice B is incorrect as increased forgetfulness is a common feature of aging and may not necessarily indicate dementia. Choice C is incorrect as forgetting names of familiar people can also be a normal part of aging and does not solely point to dementia. Memory loss affecting daily functioning is a more specific and severe symptom that strongly suggests dementia over normal aging.

Correct Answer: A

Rationale: The correct answer is A because clients with hearing loss typically have difficulty hearing high-pitched tones, making it easier for them to respond to low-pitched tones. Low-pitched tones are easier for individuals with hearing loss to perceive due to the nature of hearing loss affecting the ability to hear higher frequencies. Choice B is incorrect as it is a generalization that does not consider the specific nature of hearing loss. Choice C is incorrect because individuals with hearing loss may require various forms of assistance beyond just lip-reading. Choice D is incorrect as individuals with hearing loss generally struggle more with high-pitched tones.

Correct Answer: D

Rationale: The correct answer is D: Speak clearly. This is important when addressing older adults as many may have hearing impairments. Speaking clearly helps ensure they can understand and follow instructions. Using an exaggerated pitch (A) may come across as patronizing. Using a lower quality of speech (B) can be perceived as disrespectful. Using endearing terms (C) may not be appropriate for all individuals and can be seen as condescending. In summary, speaking clearly is the most effective way to communicate respectfully with older adults.