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Question

Difficulty: MediumAging Process

A triage nurse at a primary care clinic is reviewing telephone messages from the caregivers of four older adult clients. Which client should the nurse contact first?

  1. A
    A 77-year-old client who recently developed flat, dark purple patches on the extensor surfaces of both hands after minor bumps.
  2. B
    An 81-year-old client whose family is concerned because the client's baseline morning body temperature typically measures 97.1°F (36.2°C).
  3. An 84-year-old client whose caregiver reports a sudden onset of urinary incontinence and unexplained restlessness that began this morning.Answer
  4. D
    A 79-year-old client who requires significantly brighter light to read the newspaper and takes longer to adjust to dark rooms.

Answer

The client whose caregiver reports a sudden onset of urinary incontinence and unexplained restlessness that began this morning.
The correct answer identifies an acute, unexpected change in the client's baseline status. Sudden onset of urinary incontinence and cognitive or behavioral changes (such as restlessness) are not normal parts of the aging process. These symptoms frequently represent an atypical presentation of an acute illness in older adults, such as a urinary tract infection (UTI), hypoxia, or adverse medication effects, and require immediate medical evaluation.

Step-by-Step Solution

1
Analyze the client presentations in the stem.
The nurse must prioritize four older adult clients based on the acuity and stability of their reported findings.
Prioritization requires identifying which client is experiencing an acute, unstable, or potentially life-threatening condition.
2
Evaluate each option to differentiate normal aging from acute pathology.
Senile purpura (dark purple skin patches), decreased basal body temperature, and visual changes (requiring more light) are all expected, chronic physiological adaptations to aging.
Recognizing normal senescence prevents unnecessary interventions for expected age-related changes.
3
Identify the unexpected, acute finding.
Sudden urinary incontinence and new-onset restlessness indicate an acute change in condition.
In older adults, acute infections (like a UTI) or metabolic imbalances often present atypically with sudden confusion, restlessness, or loss of continence rather than classic symptoms like a high fever.

Key Concept

Normal Physiological Changes of Aging vs. Acute Pathology
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Topics

Aging Process

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